Clicklaw Wikibooks - User contributions [en]

Home Care

2024-10-31T18:51:19Z

Justin Lee: /* Private Home Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

[http://Route65.ca Route65.ca] offers a network of credible home care agencies, as well as further resources for choosing a service provider, including downloadable checklists on their [https://route65.ca/assurity-info/ Assurity page] that people can use to help screen home care and independent living providers. You can find a list of home care agencies on the Route65.ca directory [https://route65.ca/search/?type=place&category=home-health-care&sort=random here] and filter by city to locate services in your community.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

Route65.ca lists various operators of palliative care services. Users can find a current list using the palliative care search filter [https://route65.ca/search/?type=place&healthcare-services=Palliative%2BCare,Palliative%2BCare%2B%2528%2524%2529&sort=random here].

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Home Care

2024-10-31T18:50:51Z

Justin Lee: /* Private Home Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

[http://Route65.ca Route65.ca] offers a network of credible home care agencies, as well as further resources for choosing a service provider, including downloadable checklists on their [http://Assurity%20page Assurity page] that people can use to help screen home care and independent living providers. You can find a list of home care agencies on the Route65.ca directory [https://route65.ca/search/?type=place&category=home-health-care&sort=random here] and filter by city to locate services in your community.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

Route65.ca lists various operators of palliative care services. Users can find a current list using the palliative care search filter [https://route65.ca/search/?type=place&healthcare-services=Palliative%2BCare,Palliative%2BCare%2B%2528%2524%2529&sort=random here].

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Subsidized Assisted Living

2024-10-31T15:52:17Z

Justin Lee: /* Subsidized Assisted Living */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter2}}

==Subsidized Assisted Living==

Assisted living facilities may be publicly funded (subsidized), private-pay, or a combination of the two. A case manager from [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Services] within the applicant’s regional health authority will assess a person’s eligibility for assisted living services and for subsidized rates. Financially eligible residents pay a calculated client fee.

There is a minimum and maximum [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/assisted-living client rate]. If the client is between the minimum and maximum client rate, the person pays a monthly fee of 70% of their after-tax income for rent, hospitality services and assisted living services. The formula for calculating subsidized fees is set by the Ministry of Health and may be adjusted periodically. The fee paid by each resident is reviewed annually and adjusted based on the resident’s income tax return. Residents on income assistance or disability benefits pay a pre-determined set rate.

Residents may be required to pay for additional services that are not covered in the monthly rate such as telephone, hydro, cable TV, internet, medical and personal care supplies, and medications. Some facilities also require a damage deposit before the resident moves in.([[{{PAGENAME}}#References|1]])

Fee amounts and services included must be clearly outlined in the residency agreement signed on admission. Assisted living fees are commonly seen as not being subject to ''the Residential Tenancy Act''. However, the Office of the BC Seniors Advocate has recently released a report arguing that assisted living facilities are already subject to the Residential Tenancy Act.([[{{PAGENAME}}#References|2]])

Private-pay services may be purchased as a fixed-rate package, on a fee-for-service basis, or through a combination of the two. Fees for private-pay facilities are not regulated. Read your residency agreement carefully and ask questions about what services are included or not included, and additional fees.

For more resources, [https://route65.ca/category/assisted-living/ Route65.ca] has a directory of both subsidized and private pay assisted living options.

==References==
# British Columbia, “About Assisted Living,” online: <http://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/about-assisted-living>; British Columbia, Ministry of Health, “ Home and Community Care Policy Manual,” (6 February 2023) at 5.D, 7.B, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Office of the Seniors Advocate British Columbia, “It’s Time to Act: A Review of Assisted Living in B.C.” (posted 28 June 2023), online: <http://www.seniorsadvocatebc.ca/osa-reports/its-time-to-act-a-review-of-assisted-living-in-b-c/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Choosing a Long-Term Care Facility

2024-10-31T15:50:05Z

Justin Lee: /* Choosing a Long-Term Care Facility */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter3}}

==Choosing a Long-Term Care Facility==

Once a person has been assessed by Home and Community Care Services and accepted as eligible for subsidized assisted living or long-term care, they will be asked if they have a preferred facility. The adult can name up to three preferred facilities and will be waitlisted for those. An adult is free to change their choice of preferred facility up until the time they are offered a placement. The adult may be asked if they would consider another temporary option if it becomes available sooner––called an interim facility. Applicants are not required to consider interim facilities, but this option can be helpful if the adult needs immediate care and cannot get into the facility of their choice soon enough.([[{{PAGENAME}}#References|1]])

It is important for prospective residents or trusted family members to research available facilities to find out which are suitable. To find facilities in a particular community, look on the local regional health authority website, where there will be links to assisted living and long-term care facilities by location. Many care homes will have their own website with photos and further information about their philosophy of care. Individuals can contact facilities they are interested in and arrange a visit.

Suitability for the resident may be based on a variety of factors such as closeness to friends and family who would visit, policies about alcohol, smoking or visiting, availability of staff who speak the person’s language, cultural, or religious preferences, the facility’s philosophy of care, their use of restraints, and inspection reports. VCH provides a useful list of questions to ask to determine suitability in their [http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf Introduction to Long-Term Care Handbook].

Additionally, [http://Route65.ca Route65.ca] can be helpful for those seeking either subsidized or private pay Long-Term Care services. The website provides resources to explore available options in their community when selecting up to three preferred care homes to waitlist.

==References==
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Vancouver Coastal Health, “Introduction to Long-Term Care Handbook Helping you make the best choice for your care” (2019), online (pdf): <http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Choosing a Long-Term Care Facility

2024-10-31T15:49:31Z

Justin Lee: /* Choosing a Long-Term Care Facility */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter3}}

==Choosing a Long-Term Care Facility==

Once a person has been assessed by Home and Community Care Services and accepted as eligible for subsidized assisted living or long-term care, they will be asked if they have a preferred facility. The adult can name up to three preferred facilities and will be waitlisted for those. An adult is free to change their choice of preferred facility up until the time they are offered a placement. The adult may be asked if they would consider another temporary option if it becomes available sooner––called an interim facility. Applicants are not required to consider interim facilities, but this option can be helpful if the adult needs immediate care and cannot get into the facility of their choice soon enough.([[{{PAGENAME}}#References|1]])

It is important for prospective residents or trusted family members to research available facilities to find out which are suitable. To find facilities in a particular community, look on the local regional health authority website, where there will be links to assisted living and long-term care facilities by location. Many care homes will have their own website with photos and further information about their philosophy of care. Individuals can contact facilities they are interested in and arrange a visit.

Suitability for the resident may be based on a variety of factors such as closeness to friends and family who would visit, policies about alcohol, smoking or visiting, availability of staff who speak the person’s language, cultural, or religious preferences, the facility’s philosophy of care, their use of restraints, and inspection reports. VCH provides a useful list of questions to ask to determine suitability in their [http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf Introduction to Long-Term Care Handbook].

Additionally, [http://Route65.ca Route65.ca] can be helpful for those seeking either subsidized or private pay LTC services. The website provides resources to explore available options in their community when selecting up to three preferred care homes to waitlist.

==References==
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Vancouver Coastal Health, “Introduction to Long-Term Care Handbook Helping you make the best choice for your care” (2019), online (pdf): <http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Choosing a Long-Term Care Facility

2024-10-31T15:47:48Z

Justin Lee: /* Choosing a Long-Term Care Facility */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter3}}

==Choosing a Long-Term Care Facility==

Once a person has been assessed by Home and Community Care Services and accepted as eligible for subsidized assisted living or long-term care, they will be asked if they have a preferred facility. The adult can name up to three preferred facilities and will be waitlisted for those. An adult is free to change their choice of preferred facility up until the time they are offered a placement. The adult may be asked if they would consider another temporary option if it becomes available sooner––called an interim facility. Applicants are not required to consider interim facilities, but this option can be helpful if the adult needs immediate care and cannot get into the facility of their choice soon enough.([[{{PAGENAME}}#References|1]])

It is important for prospective residents or trusted family members to research available facilities to find out which are suitable. To find facilities in a particular community, look on the local regional health authority website, where there will be links to assisted living and long-term care facilities by location. Many care homes will have their own website with photos and further information about their philosophy of care. Individuals can contact facilities they are interested in and arrange a visit.

Suitability for the resident may be based on a variety of factors such as closeness to friends and family who would visit, policies about alcohol, smoking or visiting, availability of staff who speak the person’s language, cultural, or religious preferences, the facility’s philosophy of care, their use of restraints, and inspection reports. VCH provides a useful list of questions to ask to determine suitability in their [http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf Introduction to Long-Term Care Handbook].

==References==
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Vancouver Coastal Health, “Introduction to Long-Term Care Handbook Helping you make the best choice for your care” (2019), online (pdf): <http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Home Care

2024-10-31T15:46:19Z

Justin Lee: /* Palliative Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

[[Rout65.ca]] offers a network of credible home care agencies, as well as further resources for choosing a quality service provider, including downloadable checklists on their [https://route65.ca/assurity-info/ Assurity page] that people can use to screen a home care and independent living providers.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

Route65.ca lists various operators of palliative care services. Users can find a current list using the palliative care search filter [https://route65.ca/search/?type=place&healthcare-services=Palliative%2BCare,Palliative%2BCare%2B%2528%2524%2529&sort=random here].

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Home Care

2024-10-31T15:42:03Z

Justin Lee: /* Private Home Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

[[Rout65.ca]] offers a network of credible home care agencies, as well as further resources for choosing a quality service provider, including downloadable checklists on their [https://route65.ca/assurity-info/ Assurity page] that people can use to screen a home care and independent living providers.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Home Care

2024-10-31T15:41:37Z

Justin Lee: /* Private Home Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

[[Rout65.ca]] offers a network of credible home care agencies, as well as further resources for choosing a quality service provider, including downloadable checklists on their [https://route65.ca/assurity-info/ Assurity page] that people can use to screen a home care provider, as well as independent living providers.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

File:Navigating Home Care and Senior Housing - An Advocacy Guide Cover (4).png

2024-09-03T17:47:59Z

Justin Lee:

Cover photo of the Navigating Home Care and Senior Housing: An Advocacy Guide

Advocating for Older Adults in Home Care and Senior Housing

2024-08-22T23:00:24Z

Justin Lee: /* Advocating for Older Adults */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter6}}

This chapter offers some advocacy tips and outlines different avenues for resolving issues that arise in home care and care facilities for older adults.

==Advocating for Older Adults==

Older adults who are living in long-term care are likely to be physically or mentally vulnerable, and dependent on others for care. They are in the final years of life, and time is precious. Enjoying loved ones or favourite activities is likely to be a priority. Therefore, when advocating for this group it is important to aim for solutions that can be achieved in a timely way. Advocates may need to adjust their usual strategies.

When addressing problems that arise in home care and care facilities, it is important to:

* Listen to the concerns of the adult receiving care
* Involve family members and/or representatives and substitute decision-makers;
* Identify the desired outcome and timeframe for achieving it;
* Gather relevant records (with the consent of the resident, representative, or other decision-maker) including admission intake notes, initial care plan, last care plan, relevant medical diagnoses, prescriptions, and advance planning documents;
* Gather relevant rules and guidelines, such as legislation, regulations, facility policies or health authority policies;
* Consider the context in which care providers are working;
* Follow existing complaint processes respectfully;
* Keep a diary of issues, photos, and notes of all discussions with staff; and
* Keep in mind that exceptions to rules or policies can be made in some circumstances.

It is important to address the older adult’s expressed needs, as well as to involve their family or representatives. Particularly if an older adult is living with a form of dementia, involving loved ones may help identify issues and possible solutions. It can also be helpful to bring family members and other loved ones together to discuss concerns and develop a united message for communications with the care facility or any other authority. Caregivers may sometimes feel caught between conflicting directives from different family members. Providing support and guidance to caregivers in managing these complexities can help alleviate stress and improve the well-being of the older adult.

Consider advocacy approaches that the older adult will be comfortable with, and whenever possible, ask for their consent. When it is not possible to request consent, such as in situations where capacity or safety is a concern, notify the older adult about what happened and what they can expect may happen next. Confronting and negotiating with service providers or outside authorities may lead to anxiety and fears of repercussions. It is important to validate the concerns shared by the person and provide reassurance, where possible.

Consider whether the adult (or their representative) is seeking short- or long-term solutions, individual improvements, or collective policy change. Are they looking for an acceptable solution that will immediately improve their quality of life, or aiming for a policy change that could benefit many people receiving services but may take more time to achieve? Both are valid goals, but the first may be the priority for the adult receiving care. Residents or their advocates may want to pursue policy change after resolving the immediate individual issue.

Home care services and care facilities in BC are required to have a “fair, prompt and effective process” in place for addressing concerns and complaints from adults receiving care, their family members, or their substitute decision-makers. Consult the facility’s policies and wherever possible raise concerns through the processes they have in place. However, there may be circumstances where bypassing these processes is in the best interests of the resident, for example if the people who are the source of the problem are the same people responsible for overseeing complaints.

When approaching staff, keep in mind that most care facilities in BC (and across the country) face chronic staffing shortages that are beyond their control. Care quality issues may be a result of understaffing and time pressures rather than care providers lacking the skills or desire to provide excellent care.

As with any advocacy situation, it is important to document all interactions and to consult relevant documents and resources that address the issues you are concerned about.

Keep in mind that, despite extensive legislation, regulations and policy guidelines, some authorities are allowed to make exceptions to the rules if the situation calls for it.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Subsidized Assisted Living

2024-08-22T22:56:12Z

Justin Lee: /* Subsidized Assisted Living */

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==Subsidized Assisted Living==

Assisted living facilities may be publicly funded (subsidized), private-pay, or a combination of the two. A case manager from [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Services] within the applicant’s regional health authority will assess a person’s eligibility for assisted living services and for subsidized rates. Financially eligible residents pay a calculated client fee.

There is a minimum and maximum [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/assisted-living client rate]. If the client is between the minimum and maximum client rate, the person pays a monthly fee of 70% of their after-tax income for rent, hospitality services and assisted living services. The formula for calculating subsidized fees is set by the Ministry of Health and may be adjusted periodically. The fee paid by each resident is reviewed annually and adjusted based on the resident’s income tax return. Residents on income assistance or disability benefits pay a pre-determined set rate.

Residents may be required to pay for additional services that are not covered in the monthly rate such as telephone, hydro, cable TV, internet, medical and personal care supplies, and medications. Some facilities also require a damage deposit before the resident moves in.([[{{PAGENAME}}#References|1]])

Fee amounts and services included must be clearly outlined in the residency agreement signed on admission. Assisted living fees are commonly seen as not being subject to ''the Residential Tenancy Act''. However, the Office of the BC Seniors Advocate has recently released a report arguing that assisted living facilities are already subject to the Residential Tenancy Act.([[{{PAGENAME}}#References|2]])

Private-pay services may be purchased as a fixed-rate package, on a fee-for-service basis, or through a combination of the two. Fees for private-pay facilities are not regulated. Read your residency agreement carefully and ask questions about what services are included or not included, and additional fees.

==References==
# British Columbia, “About Assisted Living,” online: <http://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/about-assisted-living>; British Columbia, Ministry of Health, “ Home and Community Care Policy Manual,” (6 February 2023) at 5.D, 7.B, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Office of the Seniors Advocate British Columbia, “It’s Time to Act: A Review of Assisted Living in B.C.” (posted 28 June 2023), online: <http://www.seniorsadvocatebc.ca/osa-reports/its-time-to-act-a-review-of-assisted-living-in-b-c/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Introduction to Entering and Leaving Assisted Living

2024-08-22T22:55:36Z

Justin Lee: /* Introduction */

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==Introduction==

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/assisted-living Assisted living] provides accommodation and care for adults who can live independently and make decisions on their own behalf but require some support due to chronic or progressive conditions related to aging or disability. Assisted living facilities provide:
#accommodation,
#hospitality services, and
#assisted living services.

Assisted living facilities must be registered with the province, whether they are private-pay or publicly funded.

Assisted living facilities do not provide 24-hour care and are not required by law to have registered nurses or practical nurses supervising care. However, health authorities may require 24-hour nursing supervision in assisted living homes they fund.([[{{PAGENAME}}#References|1]])

For information specific to your region, see your regional health authority website listed in [https://wiki.clicklaw.bc.ca/index.php?title=Appendix_A_-_Resources_for_Navigating_Home_Care_and_Senior_Housing:_An_Advocacy_Guide Appendix A - Resources].

This chapter will detail what assisted living services are, eligibility for assisted living, residency agreements, subsidies, evictions, and concerns about assisted living services.

==References==
#British Columbia, ”About Assisted Living”, online: <[http://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/about-assisted-living www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/about-assisted-living]>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Supports for Caregivers

2024-08-22T22:54:06Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Supports for Caregivers==

Caring for a loved one can be rewarding, but it is also exhausting and isolating. It is important for caregivers to take breaks and look after their own health and well-being.

===Caregiver Support Line===

[https://www.familycaregiversbc.ca/ Family Caregivers of British Columbia] offers support to people caring for family members through their [https://www.familycaregiversbc.ca/get-help Caregiver Support Line] at 1-877-520-3267. For more information, visit their website.([[{{PAGENAME}}#References|1]])

===First Link Dementia Helpline===
[https://alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline The First link Dementia Helpline] offers information and support to anyone in BC caring for a person living with dementia.([[{{PAGENAME}}#References|2]])

===Respite Services ===

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief Respite services] give caregivers temporary relief from the emotional and physical demands of caring for a family member or friend. Respite care can provide opportunities for caregivers and the older adult to participate in community activities.

Respite services may be provided at home through home support services, in community through adult day services, or through short-term stays in a long-term care home, hospice or other community care setting.

The criteria to be eligible for respite services is the same as the criteria for being eligible for home care services. Additionally, the need and potential benefit to the caregiver is also assessed.

There is a cost for respite services. The cost will depend on what respite services a person uses.

To apply for respite care, contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care office] or ask a healthcare professional to make a referral.

For more information on respite care, visit the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief province’s website].([[{{PAGENAME}}#References|3]])

==References==
# Family Caregivers of British Columbia, “Home”, online: <[http://www.familycaregiversbc.ca www.familycaregiversbc.ca]>.
# First Link Dementia Helpline, “Home”, online: <[http://www.alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline http://www.alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline]>.
# British Columbia, “Caregiver Respite/Relief” (last visited 30 August 2023), online: <[http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care]>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Supports for Caregivers

2024-08-22T22:53:20Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Supports for Caregivers==

Caring for a loved one can be rewarding, but it is also exhausting and isolating. It is important for caregivers to take breaks and look after their own health and well-being.

===Caregiver Support Line===

[https://www.familycaregiversbc.ca/ Family Caregivers of British Columbia] offers support to people caring for family members through their [https://www.familycaregiversbc.ca/get-help Caregiver Support Line] at 1-877-520-3267. For more information, visit their website.([[{{PAGENAME}}#References|1]])

===First Link Dementia Helpline===
[https://alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline The First link Dementia Helpline] offers information and support to anyone in BC caring for a person living with dementia.([[{{PAGENAME}}#References|2]])

===Respite Services ===

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief Respite services] give caregivers temporary relief from the emotional and physical demands of caring for a family member or friend. Respite care can provide opportunities for caregivers and the older adult to participate in community activities.

Respite services may be provided at home through home support services, in community through adult day services, or through short-term stays in a long-term care home, hospice or other community care setting.

The criteria to be eligible for respite services is the same as the criteria for being eligible for home care services. Additionally, the need and potential benefit to the caregiver is also assessed.

There is a cost for respite services. The cost will depend on what respite services a person uses.

To apply for respite care, contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care office] or ask a healthcare professional to make a referral.

For more information on respite care, visit the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief province’s website].([[{{PAGENAME}}#References|3]])

==References==
# Family Caregivers of British Columbia, “Home”, online: <[http://www.familycaregiversbc.ca www.familycaregiversbc.ca]>.
# First Link Dementia Helpline, “Home”, online: <[http://www.alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline]>.
# British Columbia, “Caregiver Respite/Relief” (last visited 30 August 2023), online: <[http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care]>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Supports for Caregivers

2024-08-22T22:52:18Z

Justin Lee: /* Supports for Caregivers */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Supports for Caregivers==

Caring for a loved one can be rewarding, but it is also exhausting and isolating. It is important for caregivers to take breaks and look after their own health and well-being.

===Caregiver Support Line===

[https://www.familycaregiversbc.ca/ Family Caregivers of British Columbia] offers support to people caring for family members through their [https://www.familycaregiversbc.ca/get-help Caregiver Support Line] at 1-877-520-3267. For more information, visit their website.([[{{PAGENAME}}#References|1]])

===First Link Dementia Helpline===
[https://alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline The First link Dementia Helpline] offers information and support to anyone in BC caring for a person living with dementia.([[{{PAGENAME}}#References|2]])

===Respite Services ===

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief Respite services] give caregivers temporary relief from the emotional and physical demands of caring for a family member or friend. Respite care can provide opportunities for caregivers and the older adult to participate in community activities.

Respite services may be provided at home through home support services, in community through adult day services, or through short-term stays in a long-term care home, hospice or other community care setting.

The criteria to be eligible for respite services is the same as the criteria for being eligible for home care services. Additionally, the need and potential benefit to the caregiver is also assessed.

There is a cost for respite services. The cost will depend on what respite services a person uses.

To apply for respite care, contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care office] or ask a healthcare professional to make a referral.

For more information on respite care, visit the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief province’s website].([[{{PAGENAME}}#References|3]])

==References==
# Family Caregivers of British Columbia, “Home”, online: <[http://www.familycaregiversbc.ca www.familycaregiversbc.ca]>.
# British Columbia, “Caregiver Respite/Relief” (last visited 30 August 2023), online: <[http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care]>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Supports for Caregivers

2024-08-22T22:50:52Z

Justin Lee: /* Supports for Caregivers */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Supports for Caregivers==

Caring for a loved one can be rewarding, but it is also exhausting and isolating. It is important for caregivers to take breaks and look after their own health and well-being.

===Caregiver Support Line===

[https://www.familycaregiversbc.ca/ Family Caregivers of British Columbia] offers support to people caring for family members through their [https://www.familycaregiversbc.ca/get-help Caregiver Support Line] at 1-877-520-3267. For more information, visit their website.([[{{PAGENAME}}#References|1]])

===First Link Dementia Helpline===
[https://alzheimer.ca/bc/en/help-support/find-support-bc/first-link-dementia-helpline The First link Dementia Helpline] offers information and support to anyone in BC caring for a person living with dementia.

===Respite Services ===

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief Respite services] give caregivers temporary relief from the emotional and physical demands of caring for a family member or friend. Respite care can provide opportunities for caregivers and the older adult to participate in community activities.

Respite services may be provided at home through home support services, in community through adult day services, or through short-term stays in a long-term care home, hospice or other community care setting.

The criteria to be eligible for respite services is the same as the criteria for being eligible for home care services. Additionally, the need and potential benefit to the caregiver is also assessed.

There is a cost for respite services. The cost will depend on what respite services a person uses.

To apply for respite care, contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care office] or ask a healthcare professional to make a referral.

For more information on respite care, visit the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/caregiver-respite-relief province’s website].([[{{PAGENAME}}#References|2]])

==References==
# Family Caregivers of British Columbia, “Home”, online: <[http://www.familycaregiversbc.ca www.familycaregiversbc.ca]>.
# British Columbia, “Caregiver Respite/Relief” (last visited 30 August 2023), online: <[http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/care]>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Home Care

2024-08-22T22:46:42Z

Justin Lee: /* Concerns, Complaints, and Accountability */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decisions, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Home Care

2024-08-22T22:45:32Z

Justin Lee: /* Private Home Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}

==Overview of Home Care==

Sometimes informal care from family, friends and local community organizations is unavailable or unable to meet a person’s needs and keep them safe. In that case, home care can provide supplemental personal care and health care in the person’s home. Home care can be through the publicly funded home care in [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care each health authority],([[{{PAGENAME}}#References|1]]) or purchased privately.

Home care for older adults includes personal care and health care. It may be provided over a short term to support rehabilitation or to provide respite for caregivers. It can also be provided over a longer term to prevent hospitalization or admission to long-term care or assisted living.

Personal care includes help with activities of daily living such as bathing, dressing, eating and meal planning, mobility, transfers and using lifts, personal grooming and toileting, task reminders, and ensuring that a person takes their medication. Personal care may also include activities such as tidying, laundry, and meal preparation.

Most personal care is provided by health care assistants (HCAs), commonly referred to as community health workers or care aides.

Health care includes assessment of health care needs, care planning, management of medications, treatments, wound care, chronic disease management, post-surgical care, occupational therapy, physical therapy, palliative care, and assigning and supervising the work of HCAs. Health professionals also devote time to educating and supporting family caregivers.

Health care is usually provided by Licensed Practical Nurses (LPN) or Registered Nurses (RNs), in consultation with a doctor or nurse practitioner. Physical therapists and occupational therapists also provide home care.

This section will discuss eligibility for subsidized home care, how to apply, private home care services, palliative care, and concerns with home care.

==Eligibility for Subsidized Home Care==

The province sets out the requirements for subsidized home care. A person must:

* Be 19 years of age or older;
* Be a citizen or permanent resident;
* Have lived in BC for at least 90 days;
* Be eligible based on health care need;
* Be eligible based on financial need;
* Have their level of urgency assessed;
* Be living in a home that is safe for home care workers; and
* Have family caregivers be willing to take on some caregiving tasks, if the person has family caregivers.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home health office] will assess a person’s health care needs. To be eligible, the adult must be unable to function independently because of chronic health-related issues, or require care due to one or more of the following circumstances:

* care is required to prevent or reduce the need for emergency services, hospitalization or admission to a long-term care home (chronic care);
* the person is recently discharged from an acute care hospital (rehabilitation care);
* the person has time-limited acute nursing care needs (acute care); or
* the person has a life-limiting illness (palliative care).

To assess a person’s health care needs, the home care staff will use a standard assessment tool called the Resident Assessment Instrument. This assessment tool examines a person’s quality of life and functional abilities. The assessment looks at a variety of areas, including capacity, health conditions, changes to a person’s health, depression, level of pain, how well a person can perform daily activities, falls, the availability of caregivers, and caregiver distress.

Provincial legislation sets out the financial eligibility for home care and the associated client fees. Health authorities assess applicants for subsidized home care based on their annual income, or joint annual income if the person lives with a spouse.

If a person is eligible, they must agree to pay the assessed client rate to access services. Some services are free for financially eligible adults, but the adult may be required to pay for supplies in some circumstances.([[{{PAGENAME}}#References|2]])

If an adult is receiving any of the following income benefits, they can get a fee waiver or pay a reduced fee:

* the Guaranteed Income Supplement or associated spousal allowances;
* support or shelter allowance under the provincial income assistance program; or
* a War Veterans Allowance.

If paying the assessed fee would cause serious financial hardship for a person, they can apply to the health authority for a [https://connect.health.gov.bc.ca/system/files/files/forms/hcc/3992fil.pdf temporary fee reduction].

There are some exceptions available to the eligibility requirements. If you want more information about exceptions, contact your local home health office in your health authority.([[{{PAGENAME}}#References|3]])

==Applying for Subsidized Home Care==

To apply for subsidized home care, you can contact your local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] yourself, or get a referral from a doctor, social worker, or other health care professional.

When you apply for home care, the office will conduct an assessment to see if you are eligible and what your care needs are. See the province’s website for information on how to [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care prepare for an assessment].([[{{PAGENAME}}#References|4]])

If you are eligible, a health care worker will create a care plan. The care plan will be shared with you, your health care team, representatives, and family members you want involved.

There may be a wait for services to begin. Home care services are based on the urgency of the health need, the availability of health care workers, and how long the person has been on the waiting list.

For specific information about publicly funded services in your area, visit your local health authority website. They are listed in Appendix A of this guide. The listings include links to Aboriginal Patient Liaison workers who can help Indigenous patients find the services they need.

The next section will discuss hiring private home care.

==Private Home Care==

People can hire private pay home care services. A person may do this if they do not qualify for government subsidized services or if they wish to access extra services. Private pay service providers may be individuals or businesses. You access these services by contacting a service provider directly.

Private pay services are mostly unregulated. Exercise caution when using these services. For example, ask about the company’s screening and training practices, the insurance they carry, and their complaint processes. When hiring an individual, ask about their credentials and check their references. Read the service contract carefully and make sure it clearly spells out fees and what services they include.

Some tips for hiring a private service provider:

* Interview each candidate in depth. Screen applicants on the phone but always follow up with an in-person interview.
* Be specific about all the tasks, skills, languages, and schedules involved and be sure that the person you are considering is comfortable with all of them.
• If there is a particular situation that you are concerned about, such as a family member living with dementia sending the care provider away upon arrival, then be up front about this with the agency.
* Discuss compensation and payment schedules. Do not pay for services in advance.
* Request several work and personal references and check them carefully. Verify the information provided, and ask all references about reliability, trustworthiness, punctuality, and the care provider’s ability to handle stress.
* Perform background checks. If you are hiring through an agency, background checks are usually done in advance, but it is helpful to ask exactly what they cover. There are also online agencies that offer inexpensive waitlist background checks to help identify potentially serious problems.
* If the person is not the right fit, keep looking. It is important that you feel comfortable with the individual delivering services in your home.
* If you are not satisfied with a service, try talking to the company or individual care provider to see if the issue can be resolved. If not, start looking for other options soon.
* When hiring an individual person to provide care, rather than through a company, consult with your home insurance provider to see if you’ll need additional insurance to cover risks such as theft or in-home accidents by the caregiver.

==Palliative Care==

A person with a life-limiting illness may receive [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care palliative care]. Palliative care focuses on maintaining a person’s quality of life through pain management and other services. It can be provided alongside treatment for an illness. Once a patient is designated as palliative, the Medical Services Plan will pay for certain services, medications and supplies that are specific to palliative care. It also pays a fee to physicians providing palliative care supervision.

Palliative care can be provided in a number of settings, including in the home through home care services. The eligibility and application for home-based palliative care is the same as other home care services.

==Concerns, Complaints, and Accountability==

If you have concerns or complaints about public or private home care, you have several avenues to get accountability. This includes complaints through a:

* health authority;
* Patient Care Quality Office; or
* health profession regulator.

''Health Authorities''

Health authorities are required to have clear procedures in place for dealing with complaints about home and community care. Health authorities must also ensure that clients have access to information about how to express concerns about home and community care services. This includes concerns a person may have about:

* eligibility and access;
* the type, quality, and frequency of services allocated; and
* fees and fee waivers.

For example, if a person disagrees with the results of an assessment they can appeal directly through their local health authority. A person can appeal a range of decision, including the services authorized, assessed rates, and general eligibility.

''Patient Care Quality Office''

Through the Patient Care Quality office, a person can make a complaint about the quality of the care they received within that health authority. The office may facilitate a resolution. If a person does not believe that their complaint was resolved in a satisfactory way, the person can request a review from the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Review Board].([[{{PAGENAME}}#References|5]]) The review board will review any outstanding concerns, including the way the Patient Care Quality Office responded to the complaint. See Appendix A for a list of PCQOs.

''Health profession regulator''

Regulated health professionals are governed by colleges, which set out practice and ethics standards. A person can make a complaint about an individual regulated health professional to that person’s college. Regulated health professionals include doctors,([[{{PAGENAME}}#References|6]]) nurses,([[{{PAGENAME}}#References|7]]) occupational therapists,([[{{PAGENAME}}#References|8]]) physical therapists,([[{{PAGENAME}}#References|9]]) speech and language pathologists,([[{{PAGENAME}}#References|10]]) dentists,([[{{PAGENAME}}#References|11]]) pharmacists,([[{{PAGENAME}}#References|12]]) and some mental health professionals.([[{{PAGENAME}}#References|13]])

A member of the public can make a complaint about a regulated professional, and the college must investigate. If the health professional has engaged in professional misconduct, they can face disciplinary action. A complaint to the college will not lead to compensation but may trigger outcomes for the health professional and improve health care practices.

''Care Aide and Community Health Worker Registry''

In BC, there is a [https://www.cachwr.bc.ca/ Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|14]]) Any health care assistant (HCA) who is working at a publicly funded facility must be registered with the Registry. However, the oversight of care aides is minimal. An HCA is eligible to be registered if they have completed an approved BC training program or an equivalent program. If an employer suspends or fires an HCA because they are suspected of abusing or neglecting a patient or client, this must be reported to the registry. The registry will investigate. If the allegations are found to be true, the HCA is removed from the registry.([[{{PAGENAME}}#References|15]])

The registry is very limited in terms of the public. The public cannot make a complaint about an HCA. This can only be made by an employer. The results of an investigation are not made public, even if they are found to be true. Additionally, the public does not have access to the registry. The public cannot check if the HCA is registered, and therefore has taken an approved education program. Only publicly funded employers can access the registry.([[{{PAGENAME}}#References|16]])

If an HCA works for a company that does not receive public funding, or works privately on their own, the HCA does not have to be registered, or complete any training programs.([[{{PAGENAME}}#References|17]])

If you are thinking of hiring an HCA yourself, you should carefully check the care aide’s education and work record. If you are using a home care agency, check their hiring and training policies, and their insurance coverage. A private home care agency may be listed in the Better Business Bureau.

==References==
# British Columbia “Home & Community Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at chs 2.B 4.B & 7B online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia Ministry of Health “Home and Community Care Policy Manual” (6 February 2023) at ch 2.B 7.D online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia “How to Arrange for Care” (last visited 30 August 2023) online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care>.
# British Columbia Patient Care Quality Review Boards “Clear. Consistent. Timely. Transparent. “Request a Review” (last visited 30 August 2023) online: <https://www.patientcarequalityreviewboard.ca>.
# College of Physicians and Surgeons of British Columbia “Home” online: <[http://www.cpsbc.ca www.cpsbc.ca]>.
# British Columbia College of Nurses & Midwives “Home” online: <[http://www.bccnm.ca www.bccnm.ca]>.
# College of Occupational Therapists of British Columbia “Home” online: <[http://www.cotbc.org www.cotbc.org]>.
# College of Physical Therapists of British Columbia “Home” online: <[http://www.cptbc.org www.cptbc.org]>.
# College of Speech and Hearing Health Professionals of British Columbia “Home” online: <[http://www.cshbc.ca www.cshbc.ca]>.
# British Columbia College of Oral Health Professionals “Home” online: <[http://www.oralhealthbc.ca www.oralhealthbc.ca]>.
# College of Pharmacists of British Columbia “Home” online: <[http://www.bcpharmacists.org www.bcpharmacists.org]>.
# College of Psychologists of British Columbia “Home” online: <[http://www.collegeofpsychologists.bc.ca www.collegeofpsychologists.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “Home” online: <[http://www.cachwr.bc.ca www.cachwr.bc.ca]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.
# Krista James & Sara Pon ''Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants CCEL Study Paper 11'' (October 2022: British Columbia Law Institute) at pg 124 to 130 online: ''British Columbia Law Institute'' online: <[http://www.bcli.org/project/hca-oversight-in-bc www.bcli.org/project/hca-oversight-in-bc]>.
# BC Care Aide and Community Health Worker Registry “About the Registry” online: <https://www.cachwr.bc.ca/about-the-registry/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Supports for Independent Living

2024-08-22T22:39:41Z

Justin Lee: /* Medical Travel Assistance */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}
==Supports for Independent Living==

A range of supports are available for older adults to enable them to live in their own home longer. These can include help with house maintenance, housekeeping, transportation, shopping, meal preparation, and companionship.

This section will describe how to find supports, the Better at Home program, adult day programs, and medical travel assistance.

===How to Find Supports===

Supports are provided by provincial programs, community agencies, volunteer organizations, and religious organizations.

[https://seniorsfirstbc.ca/ Seniors First BC]([[{{PAGENAME}}#References|1]]) operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL), where seniors and their caregivers can get help addressing issues that affect the senior’s well-being. Professional intake workers are available every day, except statutory holidays. SAIL staff offer information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference, for clients who are deaf or hard of hearing are available with advance notice. Contact SAIL at 604-437-1940 or toll-free at 1-866-437-1940.

[https://bc.211.ca/ bc211] is a free, confidential, and multilingual provincial information and referral service to a wide range of community, social, and government services. The phone line is available 24/7 by calling or texting 211.([[{{PAGENAME}}#References|2]])

To learn more about the programs in your community you can contact your local government and ask whether they have a directory of seniors’ services. You can also contact your local [https://bccrns.ca/search Community Response Network,] which has a list of community services for older adults in communities across the province.([[{{PAGENAME}}#References|3]])

If you are Indigenous, you may be able to get services through the [https://www.fnha.ca/ First Nations Health Authority]. More information about their programs can be found on their website.([[{{PAGENAME}}#References|4]])

===Better at Home Program===

[https://betterathome.ca/ Better at Home] is a program managed by the United Way, with funding provided by the provincial government. Better at Home provides a range of services to seniors living independently throughout the province. These services are delivered by local non-profit organizations and may be provided by volunteers or paid staff.([[{{PAGENAME}}#References|5]])

The services vary by community and may include:

* friendly visits;
* rides to appointments;
* light yard work;
* minor home repairs;
* light housekeeping;
* grocery shopping; and
* snow shoveling.([[{{PAGENAME}}#References|6]])

A fee for some services may be charged based on the recipient’s income, but services are usually free for low-income seniors.

You can find out what services are available in your community by calling the main line at 604-268-1312 or visiting the website.([[{{PAGENAME}}#References|7]])

===Adult Day Programs===

Adult day programs offer supportive group programs and recreational activities to older adults and adults living with disabilities. These programs are offered one to two days a week at a location in the community.

To get into an adult day program, a person must apply to their local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home and community care office]'''.''' This office will assess the person’s eligibility and determine what services the person can receive.

For more information on adult day programs, visit the province’s website.([[{{PAGENAME}}#References|8]])

===Medical Travel Assistance ===

In addition to the local transportation help offered by Better at Home, there are two provincial programs that help B.C. residents travel to non-emergency medical services outside their home community: the Travel Assistance Program, and Health Connections.

For emergency transportation to medical services, call 911.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc Travel Assistance Program] (TAP) provides travel vouchers for specific transportation services, such as BC Ferries and Harbour Air. You must apply for TAP before you travel. Apply early to allow enough time for the application to be processed before the intended travel date. If you require an escort for medical reasons, the escort may also qualify for TAP.

The TAP program does not cover all medical travel. It does not make direct payments to people, it only provides travel vouchers. It does not reimburse people for travel expenses (such as mileage, fuel, local transportation expenses, meals or accommodation). It does not pay for travel already taken.

There are eligibility requirements for TAP. Only certain kinds of medical services are eligible for travel coverage. For details about who is eligible, what is covered, and how to apply, see the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc province’s webpage].([[{{PAGENAME}}#References|9]])

TAP is a partnership between health authorities and transportation providers to increase access to non-emergency medical appointments for residents in rural or remote areas of BC. The program offers subsidized transportation for rural residents who require non-emergency, physician-referred medical care outside their home community. Services vary by community. Details can be found on local health authority websites or the province’s website.([[{{PAGENAME}}#References|10]])

If you are First Nations (with Indian status) travelling for non-emergency medical specialist services, you may be eligible for a benefit through the First Nations Health Authority. Specific information regarding these benefits can be found by contacting your local First Nations Health Authority office or [http://www.fnha.ca/benefits/medical-transportation visiting the website].([[{{PAGENAME}}#References|11]])

==References==
# Seniors First BC, “Seniors Abuse and Information Line” (last reviewed April 2023), online: <https://www.seniorsfirstbc.ca>.
# United Way British Columbia, “Helpline Services: Connecting People to Community Resources” (last visited 29 August 2023), online: <https://www.bc211.ca>.
# BC Association of Community Response Networks, “Find a CRN” (last visited 29 August 2023), online: <https://bccrns.ca/search>.
# First Nations Health Authority, “What We Do,” online: <https://www.fnha.ca/what-we-do>.
# Better at Home, “About Us”, online: <https://betterathome.ca/better-home-program/>.
# Better at Home, “Services Available," online: <https://betterathome.ca/services-available/>.
# Better at Home, “Map Search” (last visited 29 August 2023), online: <https://betterathome.ca/map-search>.
# British Columbia, “Adult Day Services” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/adult-day-services>.
# British Columbia, “Travel Assistance Program (TAP BC)” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc>.
# British Columbia, “Health Connections” (last visited 30 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections>.
# First Nations Health Authority, “Medical Transportation Benefit” (last visited 30 August 2023), online: <https://www.fnha.ca/benefits/medical-transportation>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Introduction to Navigating Home Care and Senior Housing

2024-08-22T22:35:44Z

Justin Lee:

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide? ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed? ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help with maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available. Older adults in this situation are considered “alternative level of care” (ALC) patients.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation, along with the ''Public Guardian and Trustee Act''([[{{PAGENAME}}#References|8]]) and ''Patients Property Act''([[{{PAGENAME}}#References|9]]), directs the PGT on how to respond to reports of abuse, neglect, and self-neglect of adults who may be vulnerable or incapable. It also outlines the process to determine if the PGT needs to get involved as committee of estate.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|10]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|11]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|11]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|12]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|13]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|14]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|15]])

==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: <[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution>].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: <https://www.canlii.ca/t/84lk>.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: <https://www.canlii.ca/t/9lrn>.
# ''Residential Care Regulation'' BC Reg 96/2009 online: <https://www.canlii.ca/t/89ln>.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: <https://www.canlii.ca/t/842m>.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: <https://www.canlii.ca/t/84gj>.
# ''Public Guardian and Trustee Act'', RSBC 1996, c 383, online: <https://www.canlii.ca/t/84b2>;.
# ''Patients Property Act'', RSBC 1996, c 349, online: <https://www.canlii.ca/t/52cd7>;.
# ''Health Professions Act'' RSBC 1996 c 183 online: <https://www.canlii.ca/t/842p>.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: <https://www.canlii.ca/t/bmzj>).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: <https://www.canlii.ca/t/84bw>.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: <https://www.canlii.ca/t/849l>.
# ''Patients Property Act'' RSBC 1996 c 349 online: <https://www.canlii.ca/t/848s>.
# ''Mental Health Act'' RSBC 1996 c 288 online: <https://www.canlii.ca/t/846j>.
# Health Justice “Home“ online: <https://www.healthjustice.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Introduction to Navigating Home Care and Senior Housing

2024-08-22T22:14:58Z

Justin Lee: /* Laws Governing Home and Community Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide? ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed? ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help with maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available. Older adults in this situation are considered “alternative level of care” (ALC) patients.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation, along with the Public Guardian and Trustee Act and Patients Property Act, directs the PGT on how to respond to reports of abuse, neglect, and self-neglect of adults who may be vulnerable or incapable. It also outlines the process to determine if the PGT needs to get involved as committee of estate.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|8]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|9]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|10]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|11]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|12]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|13]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|14]])

==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: <[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution>].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: <https://www.canlii.ca/t/84lk>.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: <https://www.canlii.ca/t/9lrn>.
# ''Residential Care Regulation'' BC Reg 96/2009 online: <https://www.canlii.ca/t/89ln>.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: <https://www.canlii.ca/t/842m>.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: <https://www.canlii.ca/t/84gj>.
# ''Health Professions Act'' RSBC 1996 c 183 online: <https://www.canlii.ca/t/842p>.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: <https://www.canlii.ca/t/bmzj>).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: <https://www.canlii.ca/t/84bw>.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: <https://www.canlii.ca/t/849l>.
# ''Patients Property Act'' RSBC 1996 c 349 online: <https://www.canlii.ca/t/848s>.
# ''Mental Health Act'' RSBC 1996 c 288 online: <https://www.canlii.ca/t/846j>.
# Health Justice “Home“ online: <https://www.healthjustice.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Introduction to Navigating Home Care and Senior Housing

2024-08-22T22:14:07Z

Justin Lee: /* Laws Governing Home and Community Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide? ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed? ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help with maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available. Older adults in this situation are considered “alternative level of care” (ALC) patients.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation, along with the Public Guardian and Trustee Act and Patients Property Act, directs the PGT on how to respond to reports of abuse, neglect, and self-neglect of adults who may be vulnerable or incapable, It also outlines the process to determine if the PGT needs to get involved as committee of estate.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|8]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|9]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|10]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|11]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|12]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|13]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|14]])

==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: <[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution>].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: <https://www.canlii.ca/t/84lk>.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: <https://www.canlii.ca/t/9lrn>.
# ''Residential Care Regulation'' BC Reg 96/2009 online: <https://www.canlii.ca/t/89ln>.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: <https://www.canlii.ca/t/842m>.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: <https://www.canlii.ca/t/84gj>.
# ''Health Professions Act'' RSBC 1996 c 183 online: <https://www.canlii.ca/t/842p>.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: <https://www.canlii.ca/t/bmzj>).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: <https://www.canlii.ca/t/84bw>.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: <https://www.canlii.ca/t/849l>.
# ''Patients Property Act'' RSBC 1996 c 349 online: <https://www.canlii.ca/t/848s>.
# ''Mental Health Act'' RSBC 1996 c 288 online: <https://www.canlii.ca/t/846j>.
# Health Justice “Home“ online: <https://www.healthjustice.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Supports for Independent Living

2024-08-22T22:08:06Z

Justin Lee: /* Supports for Independent Living */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}
==Supports for Independent Living==

A range of supports are available for older adults to enable them to live in their own home longer. These can include help with house maintenance, housekeeping, transportation, shopping, meal preparation, and companionship.

This section will describe how to find supports, the Better at Home program, adult day programs, and medical travel assistance.

===How to Find Supports===

Supports are provided by provincial programs, community agencies, volunteer organizations, and religious organizations.

[https://seniorsfirstbc.ca/ Seniors First BC]([[{{PAGENAME}}#References|1]]) operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL), where seniors and their caregivers can get help addressing issues that affect the senior’s well-being. Professional intake workers are available every day, except statutory holidays. SAIL staff offer information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference, for clients who are deaf or hard of hearing are available with advance notice. Contact SAIL at 604-437-1940 or toll-free at 1-866-437-1940.

[https://bc.211.ca/ bc211] is a free, confidential, and multilingual provincial information and referral service to a wide range of community, social, and government services. The phone line is available 24/7 by calling or texting 211.([[{{PAGENAME}}#References|2]])

To learn more about the programs in your community you can contact your local government and ask whether they have a directory of seniors’ services. You can also contact your local [https://bccrns.ca/search Community Response Network,] which has a list of community services for older adults in communities across the province.([[{{PAGENAME}}#References|3]])

If you are Indigenous, you may be able to get services through the [https://www.fnha.ca/ First Nations Health Authority]. More information about their programs can be found on their website.([[{{PAGENAME}}#References|4]])

===Better at Home Program===

[https://betterathome.ca/ Better at Home] is a program managed by the United Way, with funding provided by the provincial government. Better at Home provides a range of services to seniors living independently throughout the province. These services are delivered by local non-profit organizations and may be provided by volunteers or paid staff.([[{{PAGENAME}}#References|5]])

The services vary by community and may include:

* friendly visits;
* rides to appointments;
* light yard work;
* minor home repairs;
* light housekeeping;
* grocery shopping; and
* snow shoveling.([[{{PAGENAME}}#References|6]])

A fee for some services may be charged based on the recipient’s income, but services are usually free for low-income seniors.

You can find out what services are available in your community by calling the main line at 604-268-1312 or visiting the website.([[{{PAGENAME}}#References|7]])

===Adult Day Programs===

Adult day programs offer supportive group programs and recreational activities to older adults and adults living with disabilities. These programs are offered one to two days a week at a location in the community.

To get into an adult day program, a person must apply to their local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home and community care office]'''.''' This office will assess the person’s eligibility and determine what services the person can receive.

For more information on adult day programs, visit the province’s website.([[{{PAGENAME}}#References|8]])

===Medical Travel Assistance ===

In addition to the local transportation help offered by Better at Home, there are two provincial programs that help B.C. residents travel to non-emergency medical services outside their home community: the Travel Assistance Program, and Health Connections.

For emergency transportation to medical services, call 911.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc Travel Assistance Program] (TAP) provides travel vouchers for specific transportation services, such as BC Ferries and Harbour Air. You must apply for TAP before you travel. Apply early to allow enough time for the application to be processed before the intended travel date. If you require an escort for medical reasons, the escort may also qualify for TAP.

The TAP program does not cover all medical travel. It does not make direct payments to people, it only provides travel vouchers. It does not reimburse people for travel expenses (such as mileage, fuel, local transportation expenses, meals or accommodation). It does not pay for travel already taken.

There are eligibility requirements for TAP. Only certain kinds of medical services are eligible for travel coverage. For details about who is eligible, what is covered, and how to apply, see the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc province’s webpage].([[{{PAGENAME}}#References|9]])

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections Health Connections] is a partnership between health authorities and transportation providers to increase access to non-emergency medical appointments for residents in rural or remote areas of BC. The program offers subsidized transportation for rural residents who require non-emergency, physician-referred medical care outside their home community. Services vary by community. Details can be found on local health authority websites or the province’s website.([[{{PAGENAME}}#References|10]])

If you are First Nations (with Indian status) travelling for non-emergency medical specialist services, you may be eligible for a benefit through the First Nations Health Authority. Specific information regarding these benefits can be found by contacting your local First Nations Health Authority office or [http://www.fnha.ca/benefits/medical-transportation visiting the website].([[{{PAGENAME}}#References|11]])

==References==
# Seniors First BC, “Seniors Abuse and Information Line” (last reviewed April 2023), online: <https://www.seniorsfirstbc.ca>.
# United Way British Columbia, “Helpline Services: Connecting People to Community Resources” (last visited 29 August 2023), online: <https://www.bc211.ca>.
# BC Association of Community Response Networks, “Find a CRN” (last visited 29 August 2023), online: <https://bccrns.ca/search>.
# First Nations Health Authority, “What We Do,” online: <https://www.fnha.ca/what-we-do>.
# Better at Home, “About Us”, online: <https://betterathome.ca/better-home-program/>.
# Better at Home, “Services Available," online: <https://betterathome.ca/services-available/>.
# Better at Home, “Map Search” (last visited 29 August 2023), online: <https://betterathome.ca/map-search>.
# British Columbia, “Adult Day Services” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/adult-day-services>.
# British Columbia, “Travel Assistance Program (TAP BC)” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc>.
# British Columbia, “Health Connections” (last visited 30 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections>.
# First Nations Health Authority, “Medical Transportation Benefit” (last visited 30 August 2023), online: <https://www.fnha.ca/benefits/medical-transportation>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Supports for Independent Living

2024-08-22T22:07:24Z

Justin Lee: /* Adult Day Programs */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}
==Supports for Independent Living==

A range of supports are available for older adults to enable them to live in their own home longer. These can include help with house maintenance, housekeeping, transportation, shopping, meal preparation, and companionship.

This section will describe how to fund supports, the Better at Home program, adult day programs, and medical travel assistance.

===How to Find Supports===

Supports are provided by provincial programs, community agencies, volunteer organizations, and religious organizations.

[https://seniorsfirstbc.ca/ Seniors First BC]([[{{PAGENAME}}#References|1]]) operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL), where seniors and their caregivers can get help addressing issues that affect the senior’s well-being. Professional intake workers are available every day, except statutory holidays. SAIL staff offer information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference, for clients who are deaf or hard of hearing are available with advance notice. Contact SAIL at 604-437-1940 or toll-free at 1-866-437-1940.

[https://bc.211.ca/ bc211] is a free, confidential, and multilingual provincial information and referral service to a wide range of community, social, and government services. The phone line is available 24/7 by calling or texting 211.([[{{PAGENAME}}#References|2]])

To learn more about the programs in your community you can contact your local government and ask whether they have a directory of seniors’ services. You can also contact your local [https://bccrns.ca/search Community Response Network,] which has a list of community services for older adults in communities across the province.([[{{PAGENAME}}#References|3]])

If you are Indigenous, you may be able to get services through the [https://www.fnha.ca/ First Nations Health Authority]. More information about their programs can be found on their website.([[{{PAGENAME}}#References|4]])

===Better at Home Program===

[https://betterathome.ca/ Better at Home] is a program managed by the United Way, with funding provided by the provincial government. Better at Home provides a range of services to seniors living independently throughout the province. These services are delivered by local non-profit organizations and may be provided by volunteers or paid staff.([[{{PAGENAME}}#References|5]])

The services vary by community and may include:

* friendly visits;
* rides to appointments;
* light yard work;
* minor home repairs;
* light housekeeping;
* grocery shopping; and
* snow shoveling.([[{{PAGENAME}}#References|6]])

A fee for some services may be charged based on the recipient’s income, but services are usually free for low-income seniors.

You can find out what services are available in your community by calling the main line at 604-268-1312 or visiting the website.([[{{PAGENAME}}#References|7]])

===Adult Day Programs===

Adult day programs offer supportive group programs and recreational activities to older adults and adults living with disabilities. These programs are offered one to two days a week at a location in the community.

To get into an adult day program, a person must apply to their local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care home and community care office]'''.''' This office will assess the person’s eligibility and determine what services the person can receive.

For more information on adult day programs, visit the province’s website.([[{{PAGENAME}}#References|8]])

===Medical Travel Assistance ===

In addition to the local transportation help offered by Better at Home, there are two provincial programs that help B.C. residents travel to non-emergency medical services outside their home community: the Travel Assistance Program, and Health Connections.

For emergency transportation to medical services, call 911.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc Travel Assistance Program] (TAP) provides travel vouchers for specific transportation services, such as BC Ferries and Harbour Air. You must apply for TAP before you travel. Apply early to allow enough time for the application to be processed before the intended travel date. If you require an escort for medical reasons, the escort may also qualify for TAP.

The TAP program does not cover all medical travel. It does not make direct payments to people, it only provides travel vouchers. It does not reimburse people for travel expenses (such as mileage, fuel, local transportation expenses, meals or accommodation). It does not pay for travel already taken.

There are eligibility requirements for TAP. Only certain kinds of medical services are eligible for travel coverage. For details about who is eligible, what is covered, and how to apply, see the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc province’s webpage].([[{{PAGENAME}}#References|9]])

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections Health Connections] is a partnership between health authorities and transportation providers to increase access to non-emergency medical appointments for residents in rural or remote areas of BC. The program offers subsidized transportation for rural residents who require non-emergency, physician-referred medical care outside their home community. Services vary by community. Details can be found on local health authority websites or the province’s website.([[{{PAGENAME}}#References|10]])

If you are First Nations (with Indian status) travelling for non-emergency medical specialist services, you may be eligible for a benefit through the First Nations Health Authority. Specific information regarding these benefits can be found by contacting your local First Nations Health Authority office or [http://www.fnha.ca/benefits/medical-transportation visiting the website].([[{{PAGENAME}}#References|11]])

==References==
# Seniors First BC, “Seniors Abuse and Information Line” (last reviewed April 2023), online: <https://www.seniorsfirstbc.ca>.
# United Way British Columbia, “Helpline Services: Connecting People to Community Resources” (last visited 29 August 2023), online: <https://www.bc211.ca>.
# BC Association of Community Response Networks, “Find a CRN” (last visited 29 August 2023), online: <https://bccrns.ca/search>.
# First Nations Health Authority, “What We Do,” online: <https://www.fnha.ca/what-we-do>.
# Better at Home, “About Us”, online: <https://betterathome.ca/better-home-program/>.
# Better at Home, “Services Available," online: <https://betterathome.ca/services-available/>.
# Better at Home, “Map Search” (last visited 29 August 2023), online: <https://betterathome.ca/map-search>.
# British Columbia, “Adult Day Services” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/adult-day-services>.
# British Columbia, “Travel Assistance Program (TAP BC)” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc>.
# British Columbia, “Health Connections” (last visited 30 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections>.
# First Nations Health Authority, “Medical Transportation Benefit” (last visited 30 August 2023), online: <https://www.fnha.ca/benefits/medical-transportation>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Introduction to Navigating Home Care and Senior Housing

2024-07-24T21:36:14Z

Justin Lee: /* Acute Care */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide? ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed? ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help with maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available. Older adults in this situation are considered “alternative level of care” (ALC) patients.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation also outlines the Public Guardian and Trustee’s abilities to act as a substitute decision-maker for financial decisions, called a statutory property guardian.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|8]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|9]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|10]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|11]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|12]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|13]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|14]])

==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: <[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution>].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: <https://www.canlii.ca/t/84lk>.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: <https://www.canlii.ca/t/9lrn>.
# ''Residential Care Regulation'' BC Reg 96/2009 online: <https://www.canlii.ca/t/89ln>.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: <https://www.canlii.ca/t/842m>.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: <https://www.canlii.ca/t/84gj>.
# ''Health Professions Act'' RSBC 1996 c 183 online: <https://www.canlii.ca/t/842p>.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: <https://www.canlii.ca/t/bmzj>).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: <https://www.canlii.ca/t/84bw>.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: <https://www.canlii.ca/t/849l>.
# ''Patients Property Act'' RSBC 1996 c 349 online: <https://www.canlii.ca/t/848s>.
# ''Mental Health Act'' RSBC 1996 c 288 online: <https://www.canlii.ca/t/846j>.
# Health Justice “Home“ online: <https://www.healthjustice.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Introduction to Navigating Home Care and Senior Housing

2024-07-24T21:30:58Z

Justin Lee: /* Private Homes */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide? ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed? ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help with maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation also outlines the Public Guardian and Trustee’s abilities to act as a substitute decision-maker for financial decisions, called a statutory property guardian.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|8]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|9]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|10]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|11]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|12]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|13]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|14]])

==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: <[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution>].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: <https://www.canlii.ca/t/84lk>.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: <https://www.canlii.ca/t/9lrn>.
# ''Residential Care Regulation'' BC Reg 96/2009 online: <https://www.canlii.ca/t/89ln>.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: <https://www.canlii.ca/t/842m>.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: <https://www.canlii.ca/t/84gj>.
# ''Health Professions Act'' RSBC 1996 c 183 online: <https://www.canlii.ca/t/842p>.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: <https://www.canlii.ca/t/bmzj>).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: <https://www.canlii.ca/t/84bw>.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: <https://www.canlii.ca/t/849l>.
# ''Patients Property Act'' RSBC 1996 c 349 online: <https://www.canlii.ca/t/848s>.
# ''Mental Health Act'' RSBC 1996 c 288 online: <https://www.canlii.ca/t/846j>.
# Health Justice “Home“ online: <https://www.healthjustice.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Introduction to Navigating Home Care and Senior Housing

2024-07-24T21:30:40Z

Justin Lee: /* Independent Living or 55+ Housing */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

== What is this guide about? ==

This guide explains the types of personal care and health care that are available to older adults in British Columbia (BC). Many of these services are subsidized by community services or the BC Ministry of Health to make them affordable for most British Columbians. Some services are also available privately to people who can afford them.

This guide outlines some key laws that govern home and residential care services, including what people have a right to expect and what service providers must do and provide. It explains what to do when an older adult has a problem regarding the services they are receiving.

While some of the laws discussed here apply to services for a variety of people with chronic conditions (such as mental health conditions, addictions, brain injury, or developmental disabilities), the focus of this guide is on older adults and how the laws and policies apply to them.

== Who is the guide for? ==

This guide is primarily for older adults seeking or receiving personal and health care services either at home or in residential care. It may also be of use for family members, designated decision-makers, and advocates who are supporting and assisting older adults.

== Who produced the guide? ==

The guide was produced by [https://seniorsfirstbc.ca/ Seniors First BC], a charitable non-profit society that provides information, advocacy, and support to seniors across BC. Seniors First BC operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL) which offers a safe and confidential place for older adults and those who care for them to talk about issues that affect their well-being. Professional intake workers are available seven days a week, except on statutory holidays. SAIL staff provide information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference are available with advance notice. You can reach the Seniors Abuse and Information Line at 604-437-1940 or toll-free at 1-866-437-1940.

== Why is the guide needed? ==

The legal framework governing home and residential care for older adults is complex and often confusing. It may be unclear what a person’s rights are and who should be contacted about a problem. No matter how well a service is run, there are inevitably issues that arise where an older adult, their advocate, or their representative will benefit from information about the adult’s rights and how to resolve issues.

BC’s senior population is growing, and demands for home and residential care are increasing every year. Currently there are 294 long-term care facilities in BC and this number is likely to increase in the future. In addition, residents of care facilities now tend to be older than in previous decades, and the needs of those in long-term care are more complex than they used to be. Monitoring the quality of senior care is critical. It is important for advocates and others who support older adults to be well informed about the rights of seniors receiving care and strategies for resolving personal and health care problems that may arise.

== The perspective of the guide ==

This guide takes a client-centered, advocacy perspective to describe and understand the common legal matters affecting people who receive home and residential care. We use the terms “older adult,” “senior,” “resident,” or “person receiving care” to describe the people seeking or receiving services. Service providers may use terms like client, patient, or resident.

We generally use the term "service provider,” or “operator” to refer to the people who run home and residential care services. In law they may be referred to as “licensees” or “registrants.”

== Types of Housing and Care in BC ==

=== Private Homes ===

Most older adults in BC live in their own homes. Older adults can continue to live in their own homes using community supports and in-home care services.

Community supports include help maintaining the home, shopping, and transportation. Some of this may be provided free-of-charge through non-profit services or government-funded programs.

In-home care services provide both personal care and health care, collectively called home care. Health care includes nursing care, physical therapy, and occupational therapy. Personal care includes daily activities like bathing, dressing, grooming, meal preparation, mobility assistance, tidying, and laundry. These services may be paid for privately or be publicly-funded through the health authorities. Personal care will usually be provided by a health care assistant. Health care may be provided by a nurse (licensed practical nurse or registered nurse), a physical therapist, or an occupational therapist.

Home care and community supports will be discussed in Chapter 1 – Supports within the Community.

=== Independent Living or 55+ Housing ===

Older adults may choose to live in housing which is for those 55 years of age and older only. Older adults may also choose to move into a multi-unit building called independent living. People living there must be able to live independently and be capable of making decisions. Independent living includes a private apartment to live in, and hospitality services like meals and social activities.

This guide will not address independent living or 55+ housing. These types of rental accommodations are governed by the ''Residential Tenancy Act,''([[{{PAGENAME}}#References|1]]) and disputes involving tenancy matters is dealt with by the [https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/tenancy-dispute-resolution Residential Tenancy Branch’s dispute resolution] process.([[{{PAGENAME}}#References|2]])

=== Assisted Living ===

Assisted living residences are for adults who can live independently and are capable of making their own decisions, but require some supports to remain living independently. Assisted living provides accommodation, hospitality services, activities, personal care, and health care services. Once a person’s care needs get to be too high for assisted living, they would typically move to long-term care.

Assisted Living will be discussed in Chapter 2.

=== Long-Term Care ===

Long-term care is for people who cannot live independently or in assisted living, require ongoing personal care and health care, and typically have complex care needs. Residents may be vulnerable due to age, disability, illness, or frailty. Many long-term care residents have some degree of difficulty making decisions without support. However, a person living in long-term care may still be able to make all or some decisions, especially with support. It will depend on the person and the type of decision at issue.

Long-term care provides 24-hour care. Personal care is provided by care aides. Nursing care is provided by licensed practical nurses or registered nurses. Residents will also have access to doctors, physical therapists, occupational therapists, respiratory therapists, or other health care workers. Volunteers may also be at the facility providing companionship.

Long-term care residences provide meal services, usually in a communal dining room. Residences will hold social and religious activities for residences and families to participate in. Visitors are allowed to come in and interact with their friends and family members. The facility may also bring in personal care services like hairdressers at regular intervals.

=== Acute Care ===

Older adults may be receiving acute care in a hospital for an acute or ongoing illness or injury. Some people who need to go into long-term care and do not have anywhere to live in the meantime may be in a hospital for an extended period of time while waiting for a bed in long-term care to become available.

Acute and hospital care will not be covered in this guide.

== Laws Governing Home and Community Care ==

There are many pieces of legislation which govern home and community care. This section will briefly outline what those laws are.

For those who are interested in reading the specific sections of legislation, this information will be placed in the footnotes. It is not necessary to read the legislation if you are an older adult or supporter reading this guide to learn more about your housing and care options. This information is provided for advocates who may want this detailed information.

Assisted Living and Long-term Care are addressed in the ''Community Care and Assisted Living Act,''([[{{PAGENAME}}#References|3]]). Under this Act are two relevant regulations – the ''Assisted Living Regulation''([[{{PAGENAME}}#References|4]]) governing assisted living, and the ''Residential Care Regulation''([[{{PAGENAME}}#References|5]]) governing long-term care. These laws set out facility requirements, licensing rules, operation of the residence, entering and leaving the residence, rules regarding living there, and rights and responsibilities.

Consent to health care and admission to care facilities are found in the ''Health Care (Consent) and Care Facility (Admission) Act''([[{{PAGENAME}}#References|6]]). For health care consent, this legislation outlines how health care professionals must obtain consent to health care, a person’s rights in consenting or not consenting, temporary substitute decision-makers for health care, and advanced directives. For admission to long-term care, the legislation outlines how the facility must get consent, who can provide substitute consent, and emergency admissions.

Response to abuse and neglect is found in the ''Adult Guardianship Act''([[{{PAGENAME}}#References|7]]). This legislation outlines how a person can report suspected abuse to a designated agency, how the designated agency must respond, and what assistance can be provided to an adult. This legislation also outlines the Public Guardian and Trustee’s abilities to act as a substitute decision-maker for financial decisions, called a statutory property guardian.

Regulation of most health care professionals is under the ''Health Professions Act''([[{{PAGENAME}}#References|8]]), at the time of publication. This legislation governs which health professions are regulated, how the regulatory bodies are set up, and what the investigation and discipline procedures are. In the future, the new ''Health Professions and Occupations Act''([[{{PAGENAME}}#References|9]]) will come into force and take over as the legislation governing health care professionals. The new legislation will govern the same areas. It will create an oversight body which will oversee regulatory colleges, and merge many of the regulatory colleges together.

Substitute and supported decision-making is governed through the ''Representation Agreement Act''([[{{PAGENAME}}#References|10]]) and the ''Power of Attorney Act''([[{{PAGENAME}}#References|11]]). Representation agreements cover health care and personal care decisions. Power of Attorney documents cover financial and legal decisions. These laws set out how the documents must be created to be valid, what the powers and responsibilities of substitute decision-makers are, and how to revoke the documents. The ''Patients Property Act''([[{{PAGENAME}}#References|12]]) governs committees of the person and property.

Mental health laws are found in the ''Mental Health Act''([[{{PAGENAME}}#References|13]]). This guide will not be addressing mental health laws, including involuntary detention under the Act. Resources on this topic can be found on [https://www.healthjustice.ca/ Health Justice’s] website.([[{{PAGENAME}}#References|14]])

==References==
# ''Residential Tenancy Act'' SBC 2002 c 78.
# British Columbia “Dispute Resolution'''”''' (last modified 16 March 2022) online: <[https://www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution%3e. www2.gov.bc.ca/gov/content/housing-tenancy/residential-tenancies/solving-problems/dispute-resolution>].
# ''Community Care and Assisted Living Act'' SBC 2002 c 75 online: <https://www.canlii.ca/t/84lk>.
# ''Assisted Living Regulation'' BC Reg 189/2019 online: <https://www.canlii.ca/t/9lrn>.
# ''Residential Care Regulation'' BC Reg 96/2009 online: <https://www.canlii.ca/t/89ln>.
# ''Health Care (Consent) and Care Facility (Admission) Act'' RSBC 1996 c 181 online: <https://www.canlii.ca/t/842m>.
# ''Adult Guardianship Act'' RSBC 1996 c 6 online: <https://www.canlii.ca/t/84gj>.
# ''Health Professions Act'' RSBC 1996 c 183 online: <https://www.canlii.ca/t/842p>.
# The new ''Health Professions and Occupations Act'' is not yet in force (SBC 2022 c 43 online: <https://www.canlii.ca/t/bmzj>).
# ''Representation Agreement Act'' RSBC 1996 c 405 online: <https://www.canlii.ca/t/84bw>.
# ''Power of Attorney Act'' RSBC 1996 c 370 online: <https://www.canlii.ca/t/849l>.
# ''Patients Property Act'' RSBC 1996 c 349 online: <https://www.canlii.ca/t/848s>.
# ''Mental Health Act'' RSBC 1996 c 288 online: <https://www.canlii.ca/t/846j>.
# Health Justice “Home“ online: <https://www.healthjustice.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Acknowledgements for Navigating Home Care and Senior Housing: An Advocacy Guide

2024-07-24T21:27:08Z

Justin Lee: /* Acknowledgements */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC}}

==Acknowledgements==

Published by Seniors First BC, 2024

#502 – 1281 West Georgia St, Vancouver, BC V6E 3J7

[https://seniorsfirstbc.ca '''Seniors First BC'''] is a charitable, non-profit society that provides information, advocacy, and support to seniors across BC who are dealing with issues affecting their well-being.

Seniors First BC receives core funding from the Province of British Columbia and the Law Foundation of British Columbia to operate its programs across British Columbia.

Seniors First BC is grateful for funding for this particular project from the Council to Reduce Elder Abuse (CREA).

We acknowledge that Seniors First BC’s office in downtown Vancouver is located on the unceded and ancestral territory of the Coast Salish Peoples – the xʷməθkʷəy̓əm (Musqueam), Sḵwx̱wú7mesh (Squamish), and səlilwətaɬ (Tsleil-Waututh) Nations. We also acknowledge the traditional territories of all the First Nations of British Columbia on whose land we operate. We thank the people and Elders who have stewarded these lands and waters since time immemorial.

This guide may be used with acknowledgement of Seniors First BC.

Research and writing by Seniors First BC staff, including lawyers Sara Pon, Zack Uganec, and Marie-Noël Campbell, as well as Seniors Abuse and Information Line & Victim Services Manager Tina Chang, and Public Legal Education writer Pat Feindel. Editing by Liza Hughes and the Seniors First BC team. Legal Citations by Natasha Gosselin, volunteer research assistant, law student from the University of Ottawa.

Some material in this manual has been adapted from:

:Charmaine Spencer, ''Legal Issues in Residential Care: An Advocate’s Manual,'' (2014, Vancouver: BC Centre for Elder Advocacy and Support).

'''Note:''' The information in this guide should not be taken as legal advice. This material contains information and guidance for older adults seeking or receiving care and advocates and others who support them. We have made every effort to accurately reflect the law, policy and practice in this complex area of law as of August 2023. However, this is not a comprehensive legal guide. This area of law is constantly changing.

For assistance with a specific legal issue, it is advisable to speak to an advocate or lawyer. '''Seniors First BC''' can provide information, legal advice and referrals to appropriate resources. If you need help with an issue that affects your well-being or the well-being of an older adult in British Columbia, contact the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL). Call toll-free at 1-866-437-1940 on weekdays from 8 am to 8 pm and weekends from 10 am to 5:30 pm, excluding statutory holidays. Language interpretation is available.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Designated Agencies for Home Care and Senior Housing

2024-03-21T00:55:28Z

Justin Lee: /* Designated Agencies */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter7}}
==Designated Agencies ==

[https://bccrns.ca/adult-abuse/designated-agencies Designated agencies] in BC receive reports of abuse and neglect of vulnerable adults who cannot seek support and assistance due to incapacity or a physical limitation. The designated Agencies are responsible for investigating reports and may provide support and assistance. Designated agencies include the five regional health authorities and Community Living BC (for adults receiving their services).([[{{PAGENAME}}#References|1]]) For their contact information, see Appendix A.

When there are concerns about abuse or neglect in long-term care or assisted living, these are considered complaints about paid caregivers, and they should be made to the appropriate licensing authority within the relevant health authority rather than a designated agency (see Appendix A).

When there are concerns about a vulnerable adult being abused or neglected by someone other than a paid caregiver, or self-neglecting, a designated agency may be able to help.

A designated agency has the authority to investigate and take necessary legal actions. Wherever possible, the designated agency responder must talk directly to the adult, involve the adult in deciding what to do, and provide the adult with the support they want and need. The designated authority may:

* interview relatives;
* contact the adult’s doctor and health team;
* contact the person managing the adult’s affairs (attorney, representative, joint bank account holder);
* report criminal offences to the police;
* report to the PGT or other agencies;
* apply for an access order from Provincial Court, Family Division in non-emergency situations to enter the premises and interview the adult, or have health care providers examine the adult and determine if they need care; and
* seek an entry warrant from a Judicial Justice of the Peace or a Provincial Court judge for the purpose of interviewing the adult, if the process to obtain an access order will cause a delay that could result in further harm to the adult. This does not allow health care providers to examine the adult.([[{{PAGENAME}}#References|2]])

There are some misconceptions about what reporting abuse and neglect to a designated agency will result in. The team does not:

* perform wellness checks (checking on an adult without a report of abuse or neglect) - this is done by the police;
* respond to emergencies - a person must call 911 in an emergency;
* provide support to adults who can reach out for supports on their own - a supporter or adult can call SAIL to get a list of community resources; or
* investigate reports of abuse by staff that can typically be resolved by the Patient Care Quality Office or licensing or the assisted living registry - call the applicable agency to make a report.

==References==
# “Designated Agencies Regulation,” BC Reg 19/2002, online: <http://canlii.ca/t/850b>; “Adult Guardianship Act,” RSBC 1996, c 6, s 44, online: <http://canlii.ca/t/84gj>.
# “Adult Guardianship Act,” RSBC 1996, c 6, ss 48-49, 51, & 59, online: <http://canlii.ca/t/84gj>

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
{{Navigating Home Care and Senior Housing: An Advocacy Guide Navbox}}

Supports for Independent Living

2024-03-21T00:48:54Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter1}}
==Supports for Independent Living==

A range of supports are available for older adults to enable them to live in their own home longer. These can include help with house maintenance, housekeeping, transportation, shopping, meal preparation, and companionship.

This section will describe how to fund supports, the Better at Home program, adult day programs, and medical travel assistance.

===How to Find Supports===

Supports are provided by provincial programs, community agencies, volunteer organizations, and religious organizations.

[https://seniorsfirstbc.ca/ Seniors First BC]([[{{PAGENAME}}#References|1]]) operates the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information Line] (SAIL), where seniors and their caregivers can get help addressing issues that affect the senior’s well-being. Professional intake workers are available every day, except statutory holidays. SAIL staff offer information, referrals, emotional support, and safety planning. Language interpretation and American Sign Language interpretation via videoconference, for clients who are deaf or hard of hearing are available with advance notice. Contact SAIL at 604-437-1940 or toll-free at 1-866-437-1940.

[https://bc.211.ca/ bc211] is a free, confidential, and multilingual provincial information and referral service to a wide range of community, social, and government services. The phone line is available 24/7 by calling or texting 211.([[{{PAGENAME}}#References|2]])

To learn more about the programs in your community you can contact your local government and ask whether they have a directory of seniors’ services. You can also contact your local [https://bccrns.ca/search Community Response Network,] which has a list of community services for older adults in communities across the province.([[{{PAGENAME}}#References|3]])

If you are Indigenous, you may be able to get services through the [https://www.fnha.ca/ First Nations Health Authority]. More information about their programs can be found on their website.([[{{PAGENAME}}#References|4]])

===Better at Home Program===

[https://betterathome.ca/ Better at Home] is a program managed by the United Way, with funding provided by the provincial government. Better at Home provides a range of services to seniors living independently throughout the province. These services are delivered by local non-profit organizations and may be provided by volunteers or paid staff.([[{{PAGENAME}}#References|5]])

The services vary by community and may include:

* friendly visits;
* rides to appointments;
* light yard work;
* minor home repairs;
* light housekeeping;
* grocery shopping; and
* snow shoveling.([[{{PAGENAME}}#References|6]])

A fee for some services may be charged based on the recipient’s income, but services are usually free for low-income seniors.

You can find out what services are available in your community by calling the main line at 604-268-1312 or visiting the website.([[{{PAGENAME}}#References|7]])

===Adult Day Programs===

Adult day programs offer supportive group programs and recreational activities to older adults and adults living with disabilities. These programs are offered one to two days a week at a location in the community.

To get into an adult day program, a person must apply to their local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office]'''.''' This office will assess the person’s eligibility and determine what services the person can receive.

For more information on adult day programs, visit the province’s website.([[{{PAGENAME}}#References|8]])

===Medical Travel Assistance ===

In addition to the local transportation help offered by Better at Home, there are two provincial programs that help B.C. residents travel to non-emergency medical services outside their home community: the Travel Assistance Program, and Health Connections.

For emergency transportation to medical services, call 911.

The [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc Travel Assistance Program] (TAP) provides travel vouchers for specific transportation services, such as BC Ferries and Harbour Air. You must apply for TAP before you travel. Apply early to allow enough time for the application to be processed before the intended travel date. If you require an escort for medical reasons, the escort may also qualify for TAP.

The TAP program does not cover all medical travel. It does not make direct payments to people, it only provides travel vouchers. It does not reimburse people for travel expenses (such as mileage, fuel, local transportation expenses, meals or accommodation). It does not pay for travel already taken.

There are eligibility requirements for TAP. Only certain kinds of medical services are eligible for travel coverage. For details about who is eligible, what is covered, and how to apply, see the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc province’s webpage].([[{{PAGENAME}}#References|9]])

[https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections Health Connections] is a partnership between health authorities and transportation providers to increase access to non-emergency medical appointments for residents in rural or remote areas of BC. The program offers subsidized transportation for rural residents who require non-emergency, physician-referred medical care outside their home community. Services vary by community. Details can be found on local health authority websites or the province’s website.([[{{PAGENAME}}#References|10]])

If you are First Nations (with Indian status) travelling for non-emergency medical specialist services, you may be eligible for a benefit through the First Nations Health Authority. Specific information regarding these benefits can be found by contacting your local First Nations Health Authority office or [http://www.fnha.ca/benefits/medical-transportation visiting the website].([[{{PAGENAME}}#References|11]])

==References==
# Seniors First BC, “Seniors Abuse and Information Line” (last reviewed April 2023), online: <https://www.seniorsfirstbc.ca>.
# United Way British Columbia, “Helpline Services: Connecting People to Community Resources” (last visited 29 August 2023), online: <https://www.bc211.ca>.
# BC Association of Community Response Networks, “Find a CRN” (last visited 29 August 2023), online: <https://bccrns.ca/search>.
# First Nations Health Authority, “What We Do,” online: <https://www.fnha.ca/what-we-do>.
# Better at Home, “About Us”, online: <https://betterathome.ca/better-home-program/>.
# Better at Home, “Services Available," online: <https://betterathome.ca/services-available/>.
# Better at Home, “Map Search” (last visited 29 August 2023), online: <https://betterathome.ca/map-search>.
# British Columbia, “Adult Day Services” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/adult-day-services>.
# British Columbia, “Travel Assistance Program (TAP BC)” (last visited 29 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/travel-assistance-program-tap-bc>.
# British Columbia, “Health Connections” (last visited 30 August 2023), online: <https://www2.gov.bc.ca/gov/content/health/accessing-health-care/tap-bc/health-connections>.
# First Nations Health Authority, “Medical Transportation Benefit” (last visited 30 August 2023), online: <https://www.fnha.ca/benefits/medical-transportation>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Public Guardian and Trustee Intervention in Home Care and Senior Housing

2024-03-21T00:47:28Z

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==Public Guardian and Trustee ==

The Public Guardian and Trustee of BC (PGT) has authority to intervene where a vulnerable adult is facing abuse, neglect, or self-neglect, particularly when they are unable to manage their financial affairs, or when someone else is managing their financial affairs inappropriately. This includes misuse of a Power of Attorney or Representation Agreement.([[{{PAGENAME}}#References|1]])

When you report a potentially abusive situation to the PGT, their staff will gather information and determine if further investigation is required. They can offer initial support by:

* providing information about options available to help the adult;
* consulting on complex risk situations of abuse, neglect, or self-neglect; or
* starting an investigation, if needed.

The PGT will conduct an investigation if:

* there is a concern the adult may be incapable of managing their affairs;
* there is specific, urgent, or immediate need; and
* no other suitable person is willing or able to act on the adult’s behalf.([[{{PAGENAME}}#References|2]])

The PGT can investigate whether an existing substitute decision-maker is fulfilling their legal duties, explore options to protect and manage the adult’s financial affairs, and assess whether the adult faces serious enough risk to require the appointment of a substitute decision-maker.([[{{PAGENAME}}#References|3]])

The PGT has the power to request from a substitute decision-maker the detailed financial, health, and personal records of the adult. If the PGT finds a substitute decision-maker is mishandling funds, they have the power to freeze the accounts affected and stop the sale or transfer of property. The PGT can appoint a new substitute decision-maker, or if no one else is available, act as the substitute decision-maker.([[{{PAGENAME}}#References|4]])

Note: In BC there is a non-profit organization called the Bloom Group which will manage the finances of low-income individuals for a nominal fee.

==References==
# Public Guardian and Trustee of British Columbia, “Assessment and Investigation Services,” online: <http://www.trustee.bc.ca/services/services-to-adults/pages/assessment-and-investigation-services.aspx>; “Adult Guardianship Act,” RSBC 1996, c 6, ss 47, 51, & 56, online: <http://canlii.ca/t/84gj>; “Public Guardian and Trustee Act,” RSBC 1996, c 383, s 17, online: <http://canlii.ca/t/84b2>.
# “Public Guardian and Trustee Act,” RSBC 1996, c 383, s 17, online: <http://canlii.ca/t/84b2>.
# “Public Guardian and Trustee Act,” RSBC 1996, c 383, s 17, online: <http://canlii.ca/t/84b2>.
# “Public Guardian and Trustee Act,” RSBC 1996, c 383, s 18-19, online: <http://canlii.ca/t/84b2>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Designated Agencies for Home Care and Senior Housing

2024-03-21T00:46:27Z

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==Designated Agencies ==

[https://bccrns.ca/adult-abuse/designated-agencies Designated agencies] in BC are responsible for responding to reports of abuse or neglect of vulnerable adults who have no one to act on their behalf. Designated agencies include the five regional health authorities and Community Living BC (for adults receiving their services).([[{{PAGENAME}}#References|1]]) For their contact information, see Appendix A.

When there are concerns about abuse or neglect in long-term care or assisted living, these are considered complaints about paid caregivers, and they should be made to the appropriate licensing authority within the relevant health authority rather than a designated agency (see Appendix A).

When there are concerns about a vulnerable adult being abused or neglected by someone other than a paid caregiver, or self-neglecting, a designated agency may be able to help.

A designated agency has the authority to investigate and take necessary legal actions. Wherever possible, the designated agency responder must talk directly to the adult, involve the adult in deciding what to do, and provide the adult with the support they want and need. The designated authority may:

* interview relatives;
* contact the adult’s doctor and health team;
* contact the person managing the adult’s affairs (attorney, representative, joint bank account holder);
* report criminal offences to the police;
* report to the PGT or other agencies;
* apply for an access order from Provincial Court, Family Division in non-emergency situations to enter the premises and interview the adult, or have health care providers examine the adult and determine if they need care; and
* seek an entry warrant from a Judicial Justice of the Peace or a Provincial Court judge for the purpose of interviewing the adult, if the process to obtain an access order will cause a delay that could result in further harm to the adult. This does not allow health care providers to examine the adult.([[{{PAGENAME}}#References|2]])

There are some misconceptions about what designated agencies can do. They do not:

* perform wellness checks (checking on an adult without a report of abuse or neglect);
* respond to emergencies;
* provide support to adults who can reach out for supports on their own; or
* investigate reports of abuse by staff that can typically be resolved by the Patient Care Quality Office or licensing or the assisted living registry.

==References==
# “Designated Agencies Regulation,” BC Reg 19/2002, online: <http://canlii.ca/t/850b>; “Adult Guardianship Act,” RSBC 1996, c 6, s 44, online: <http://canlii.ca/t/84gj>.
# “Adult Guardianship Act,” RSBC 1996, c 6, ss 48-49, 51, & 59, online: <http://canlii.ca/t/84gj>

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Abuse or Neglect by Paid Caregivers in Home Care and Senior Housing

2024-03-21T00:45:53Z

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==Abuse or Neglect by Paid Caregivers==

Care providers must ensure older adults receiving care are protected from abuse and neglect by anyone in a position of trust or authority in the facility. When they receive a complaint of abuse or neglect, care providers are required to take immediate action to prevent further abuse or neglect. They must investigate the complaint and may suspend or terminate the employee and, if necessary, call the police.([[{{PAGENAME}}#References|1]])

If you are concerned about abuse or neglect of an older adult receiving home care, you can raise your concern with the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office].

If your concern is about someone in long-term care or assisted living, raise it with the Director of Care or manager of the care facility. They are required to act on the allegation and to report it to:

* the appropriate licensing body;
* the resident’s contact person;
* the adult’s doctor or nurse practitioner; and
* any funding program that the adult benefits from.([[{{PAGENAME}}#References|2]])

However, if this does not result in an acceptable solution, the adult or their representative or advocate may make a complaint to the licensing or registration office directly, or to the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html Patient Care Quality Office].

==References==
# “Residential Care Regulation,” BC Reg 96/2009, ss 52, 77, online: <http://canlii.ca/t/89ln>; “Assisted Living Regulation,” BC Reg 189/2019, ss 50-51, online: <http://canlii.ca/t/9lrn>.
# “Residential Care Regulation,” BC Reg 96/2009, s 77, online: <http://canlii.ca/t/89ln>; “Assisted Living Regulation,” BC Reg 189/2019, s 51, online: <http://canlii.ca/t/9lrn>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Capacity and Vulnerability in Home Care and Senior Housing

2024-03-21T00:45:16Z

Justin Lee: /* References */

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==Capacity and Vulnerability ==

When considering how to respond if you suspect abuse or neglect, it is important to keep in mind that even if an adult seems to be in an abusive or neglectful situation, they have the right to decide whether to accept or refuse offers of help if they are capable of making such decisions.

When an adult has been assessed as incapable, their representative or substitute decision-maker can act on their behalf to secure their safety. If they do not have someone to act on their behalf, any concerned person should report their concerns to a designated agency or the Public Guardian and Trustee. See Appendix A.

If you are concerned about a capable older adult who may be abused or neglected, you can let them know about the [https://seniorsfirstbc.ca/programs/sail/ Seniors Abuse and Information] Line '''(SAIL) at 604-437-1940 or toll-free at 1-866-437-1940''', or [https://www2.gov.bc.ca/gov/content/justice/criminal-justice/victims-of-crime/victimlinkbc Victim Link] 1-800-563-0808, and offer information about local community services that could assist should they need them. If the person is in a care facility, see the section on [[Abuse or Neglect by Paid Caregivers in Home Care and Senior Housing|Abuse or Neglect by Paid Caregivers]] in this Chapter.

The Public Guardian and Trustee has developed a [https://www.trustee.bc.ca/reports-and-publications/Pages/Decision-Tree.aspx Decision Tree]([[{{PAGENAME}}#References|1]]), which helps determining the best course of action:

* If the adult is in immediate danger of physical harm, call 911.
* If not, and the adult is able to seek assistance, a supporter can help the person find community resources, or call the [https://www.ecomm911.ca/non-emergency-calls/find-your-local-non-emergency-numbers/ non-emergency police phone number] to report a suspected crime.
* If the adult cannot seek assistance and the abuse is financial, call the [https://www.trustee.bc.ca/services/services-to-adults/pages/assessment-and-investigation-services.aspx Public Guardian and Trustee].
* If the adult cannot seek assistance and the abuse is any other type, call a Designated Agency (see Appendix A).

==References==
# Public Guardian and Trustee of British Columbia, “Decision Tree: Assisting an Adult Who is Abused, Neglected or Self-Neglected,” online: <http://trustee.bc.ca/reports-and-publications/Pages/Decision-Tree.aspx>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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What is Elder Abuse and Neglect

2024-03-21T00:43:29Z

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==What is Elder Abuse and Neglect==

Abuse and neglect refer to mistreatment or inaction by people, often in a position of trust, that cause an older adult physical, emotional, psychological, financial, or sexual harm.

The ''Adult Guardianship Act (AGA'') defines abuse as “the deliberate mistreatment of an adult that causes the adult physical, mental or emotional harm, or damage or loss related to their financial affairs. It includes intimidation, humiliation, physical assault, sexual assault, overmedication, withholding needed medication, censoring mail, invasion or denial of privacy or denial of access to visitors.”([[{{PAGENAME}}#References|1]])

The ''AGA'' defines neglect as any failure to provide necessary care, assistance, guidance or attention to an adult that causes, or is reasonably likely to cause within a short period of time, serious physical, mental or emotional harm or substantial financial damage or loss.([[{{PAGENAME}}#References|2]])

Under the ''AGA'', self-neglect means any failure of an adult to take care of themselves that causes, or is reasonably likely to cause, serious physical harm, mental harm, or substantial financial damage or loss. Self-neglect could include living in extremely unsanitary or hazardous conditions, suffering from malnutrition or suffering from an untreated illness or injury.([[{{PAGENAME}}#References|3]])

Long-term care([[{{PAGENAME}}#References|4]]) and assisted living([[{{PAGENAME}}#References|5]]) residences are required to ensure that residents are not subjected to abuse or neglect. The regulations define([[{{PAGENAME}}#References|6]]) abuse and neglect as:

'''Physical abuse''' – “means any physical force that is excessive for, or is inappropriate to, a situation involving a person in care and perpetrated by a person not in care;”

'''Emotional abuse''' – “any act, or lack of action, which may diminish the sense of dignity of a person in care, perpetrated by a person not in care, such as verbal harassment, yelling or confinement;”

'''Sexual abuse''' – any sexual behaviour directed towards a person in care and includes

(a)any sexual exploitation, whether consensual or not, by an employee of the licensee, or any other person in a position of trust, power or authority ... but does not include consenting sexual behaviour between adult persons in care;”

'''Financial abuse''' – “(a)the misuse of the funds and assets of a person in care by a person not in care, or (b)the obtaining of the property and funds of a person in care by a person not in care without the knowledge and full consent of the person in care or that person's parent or representative;”

'''Neglect''' – “the failure of a care provider to meet the needs of a person in care, including food, shelter, care or supervision;”

==References==
# “Adult Guardianship Act,” RSBC 1996, c 6, s 1, online: <http://canlii.ca/t/84gj>.
# “Adult Guardianship Act,” RSBC 1996, c 6, s 1, online: <http://canlii.ca/t/84gj>.
# “Adult Guardianship Act,” RSBC 1996, c 6, s 1, online: <http://canlii.ca/t/84gj>.
# “Residential Care Regulation,” BC Reg 96/2009, s 52(1), online: <http://canlii.ca/t/89ln>.
# “Assisted Living Regulation,” BC Reg 189/2019, s 50, online: <http://canlii.ca/t/9lrn>.
# “Residential Care Regulation,” BC Reg 96/2009, Schedule D, s 1, online: <http://canlii.ca/t/89ln>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Seeking Systemic Change in Home Care and Senior Housing

2024-03-21T00:42:34Z

Justin Lee: /* References */

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==Seeking Systemic Change==

===Seniors Advocate===

The [https://www.seniorsadvocatebc.ca/about-us/ Office of the Seniors Advocate] was created in 2014 under the authority of the Seniors Advocate Act and is mandated to advocate and improve the well-being of seniors in BC in the areas of healthcare, personal care, housing, transportation, and income support. The Seniors Advocate gathers and analyzes information about services related to these areas, reports to government and service providers, and makes recommendations that will create systemic improvements to services and the overall well-being of seniors in BC.

The office operates an information and referral line at 1-877-952-3181 (toll free) or 250-952-3181 with translation services. They will assist by providing referrals to government and community services and guidance on navigating the health care system, but they do not take on advocacy on an individual basis. They do accept suggestions on how to improve senior services.

The Seniors Advocate office produces an annual report called [https://www.seniorsadvocatebc.ca/monitoring-seniors-services/ ''Monitoring Seniors Services'',] which highlights five year data trends on a wide range of support and services for BC seniors. It also publishes the [https://www.seniorsadvocatebc.ca/long-term-care-directory/ ''Long-Term Care and Assisted Living Directory'',] an online directory that provides information about publicly funded assisted living residences and care facilities.

===BC Office of the Ombudsperson===

The [https://bcombudsperson.ca/ BC Ombudsperson] is an independent officer appointed to ensure that every person in BC is treated fairly when using public services. The Ombudsperson is responsible for advising government on systemic causes of unfairness and for recommending changes to practices, policies and legislation that contribute to recurring unfairness.([[{{PAGENAME}}#References|1]])

The Office investigates complaints from individuals who believe they have been unfairly treated by local or provincial public services, such as hospitals, health authorities, Crown Corporations such as the Public Guardian and Trustee, and organizational bodies that regulate professionals such as the College of Physicians and Surgeons. However, some organizations fall outside its mandate. For example, it does not investigate the conduct of individual professionals such as physicians, nurses, and health care assistants.([[{{PAGENAME}}#References|2]]) For details about whether a service you are concerned about falls within the Ombudsperson’s mandate, visit the BC Ombudsperson website.([[{{PAGENAME}}#References|3]])

The office also has [https://bcombudsperson.ca/about-us/our-indigenous-services Ombudsperson Pathfinders] who will listen to the issues experienced by First Nations, Métis, Inuit and urban Indigenous people across the province. Pathfinders connect with communities to increase awareness of the Ombudsperson’s services and explain how the Ombudsperson can help identify the best avenues to remedy unfairness.([[{{PAGENAME}}#References|4]])

The Ombudsperson’s Office investigates complaints and makes recommendations to public services to remedy unfair practices.

===Human Rights Tribunal===

While the ''Residents’ Bill of Rights'' provides a framework for protecting equal rights for residents of assisted living, long-term care, and extended care, it is not the only recourse for residents with a complaint of rights violation or discrimination.

In Canada, issues of discrimination are largely addressed through human rights laws. Discrimination means being treated poorly, including being denied a service or opportunity, or having a negative decision made about you, based on a protected characteristic. Protected grounds include Indigenous identity, race, gender, ability, age, or religion.([[{{PAGENAME}}#References|5]]) Discrimination is commonly understood as racism, sexism, etc., and includes micro-aggressions. The goal of human rights processes is to repair harm, so the focus is on what happened and how it impacted the complainant, rather than whether the person or organization who discriminated intended to cause harm.

If a resident or person receiving care believes they are being denied services (or given inferior service) due to discrimination, they can make a complaint to the [http://www.bchrt.bc.ca/ BC Human Rights Tribunal.] The process of making a human rights complaint is meant to be accessible by people without lawyers, but it can still feel complicated or overwhelming. There are many resources to assist people in BC with making human rights complaints, including the [https://bchrc.net/ CLAS Human Rights Clinic].([[{{PAGENAME}}#References|6]])

==References==

# “Ombudsperson Act,” RSBC 1996, c 340, s 2, online: <http://canlii.ca/t/848h>.
# “Ombudsperson Act,” RSBC 1996, c 340, ss 10-12, Schedule, online: <http://canlii.ca/t/848h>.
# Ombudsperson British Columbia, “Complaint Checker” (last visited 30 August 2023), online:<http://bcombudsperson.ca/jurisdictional-and-non-jurisdictional-authority-list>.
# Ombudsperson British Columbia, “Services for Indigenous People,” online: <http://bcombudsperson.ca/about-us/our-indigenous-services>.
# “Human Rights Code,” RSBC 1996, c 210, s 8, online: <http://canlii.ca/t/843q>.
# Community Legal Assistance Society (CLAS), “Human Rights Complaints” (last visited 30 August 2023), online:<http://clasbc.net/get-legal-help/human-rights-complaints/>; British Columbia Human Rights Tribunal, (last visited 30 August 2023), online <http://bchrt.bc.ca>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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When Internal Advocacy Does Not Solve the Issue in Home Care and Senior Housing

2024-03-21T00:41:03Z

Justin Lee: /* References */

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==When Internal Advocacy does not Solve the Issue==

If you are not able to resolve an issue at the local service level, there are other authorities that have jurisdiction over various aspects of home and community care for older adults and can provide solutions from outside the service or facility. However, taking these routes to resolve a problem may take a longer time than dealing directly with the service provider.

[https://seniorsfirstbc.ca/ Seniors First BC] is a helpful resource that can assist with assessing a problem and identifying who to connect with for help resolving it. They also provide information and resources on senior-specific issues and support services. Call the Seniors Abuse and Information Line (SAIL) at 604-437-1940 or toll-free at 1-866-437-1940.

===Home and Community Care Office===

If you cannot resolve an issue with caregivers, case managers or care facility managers, the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] may offer assistance or guidance or refer you to the appropriate external authority, including the Patient Care Quality Office.

===Regional health authority (financial & eligibility issues)===

Decisions about eligibility for home care services or care facilities, assigned hours of care, service fees or care facility fees, or changes in home care service can be appealed directly to the regional health authority. Ask the caregiver, case manager, or [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] about how to contact the appropriate person within the health authority.

===Patient Care Quality Office===

In every health authority region, there is a Patient Care Quality Office (PCQO). They receive formal complaints about the quality of care received (including violations of care facility residents’ rights) or care that was expected but not received. Note that their mandate includes all health care, not just seniors care.

The PCQO will work with the resident or their representative to resolve the complaint. If they cannot help with the complaint, they will refer you to someone who can. They will acknowledge the complaint within two business days and aim to address it within 40 business days. Part of their purpose is to gather information about the quality of services to make recommendations to the Ministry of Health about how to improve services.

See Appendix A Resources for a list of PCQOs.

The province-wide First Nations Health Authority (FNHA) also has a [https://www.fnha.ca/what-we-do/cultural-safety-and-humility/quality-care-and-safety-office Quality Care and Safety Office].([[{{PAGENAME}}#References|1]]) They accept complaints from Indigenous adults about any public health service received in BC, in addition to specific services offered by FNHA. They can assist directly or help guide a person through the [https://www.fnha.ca/Documents/FNHA-Quality-Care-Safety-Office.pdf health authority PCQO complaint process].

If you wish to make a formal complaint to the PCQO, contact the office in your health authority region. See the [https://www.patientcarequalityreviewboard.ca/makecomplaint.html PCQO’s website] for a list of the PCQ offices in BC. Or you can contact the FNHA Quality Care and Safety Office for help with making a complaint.

If you are not satisfied with the actions or decisions of the PCQO, or if they take longer than 40 days to act or make a decision, you can contact the Patient Care Quality Review Board and request a review. PCQ Review Boards are independent from the regional PCQO. For more information, see the [https://www.patientcarequalityreviewboard.ca/ PCQ Review Board’s website].

If you are acting on behalf of someone else, you must provide the PCQ Review Board with written authorization from that person. A consent form can be found on the [https://forms2.gov.bc.ca/forms/content?id=01B3BACBC20B4981AEF8436BC0692F58 province’s website.]

Patient Care Quality Review Boards do not review:

* involuntary admissions under the ''Mental Health Act;''
* decisions by a licensing officer or medical health officer under ''the Community Care and Assisted Living Act;''
* decisions by the [https://www.bcccalab.ca/ Community Care and Assisted Living Act Appeal Board] (which deals with licensing issues); or
* matters related to private-pay services, unless provided under contract with a health authority.([[{{PAGENAME}}#References|2]])

===Director of Licensing, Medical Health Officer, or Registrar===

Assisted living and long-term care facilities must meet certain physical and operational standards under the ''Community Care and Assisted Living Act'' and its regulations, to become licensed (long-term care) or registered (assisted living). The rules for licensing and registration apply to any facility with three or more residents not related to the operator by blood or marriage.([[{{PAGENAME}}#References|3]])

You can make a complaint to the [https://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/assisted-living-registry Assisted Living Registry] or [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/finding-assisted-living-or-residential-care/residential-care-facilities/making-a-complaint-about-a-residential-care-facility Health Authority Community Care Facility Licensing] (for long-term care) if you have concerns about the overall operation of a care facility, such as the quality of care, staff skills and supervision, hygiene and communicable disease control, medication management, nutrition and food services, recreation program, physical facility (equipment and furnishings), policies and procedures, record management and reporting, or any issues that put the health and safety of residents at risk.

A licensing officer is obliged to investigate any complaint about a care facility not meeting operational standards or operating without a license. Complaints may trigger an inspection. If the inspection finds that the facility is violating standards, the operator may be required to remedy outstanding issues within a certain time frame or may have their license or registration suspended or revoked. The Ministry of Health is required to post summaries of complaint and inspection reports for the past five years on publicly accessible websites.

For private hospitals or extended care provided in a hospital, the ''Hospital Act'' governs licensing and inspections. The Ministry of Health employs inspectors to oversee standards and revoke licenses where standards are not maintained.([[{{PAGENAME}}#References|4]])

For more information about licensing for long-term care and inspection reports listed by regional health authority, see the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/finding-assisted-living-or-residential-care/residential-care-facilities/finding-a-residential-care-facility province’s website.]

For information about assisted living inspections, see the [https://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/inspection-reports province’s website.]

===Professional Oversight Bodies===

If you have concerns about the competence or conduct of a specific health care worker, such as their level of skill or ability to act professionally, and your concerns have not been addressed by any of the avenues described above, you may file a complaint with the relevant provincial body responsible for overseeing professional standards.

There are also Whistleblower Hotlines for those who wish to remain anonymous to report concerns about a health care employee. Check your regional health authority website for how to contact them. The [http://www.phsa.ca/about/accountability/safe-reporting Provincial Health Services Authority] also operates a whistleblower hotline.

For family physicians or other medical specialists, the College of Physicians and Surgeons of BC is the oversight body. If you have concerns about the clinical care or conduct of a physician, or about sexual misconduct, you can file a complaint with the College. If your concern is about a doctor working within a hospital, then file a complaint using the hospital’s complaint process. This may be done through the Patient Care Quality Office.

For nurse practitioners, registered nurses, registered psychiatric nurses and licensed practical nurses, the BC College of Nurses and Midwives receives and investigates complaints. The majority of complaints are resolved through a consensual resolution process. The outcomes of complaint investigations are summarized on their website.

To contest the outcome of a complaint about a health professional to their regulating organization, or the process has taken longer than the stated timeline for resolving complaints, you can request a review by the Health Professions Review Board within 30 days of a decision. The Review Board can review individual decisions, but only to decide whether the regulating body used procedures that were transparent, objective, impartial and fair. The Review Board cannot reinvestigate or change the original decision, they can only refer the matter back to the regulating college if they find the process has been unfair.

For health care assistants (HCAs), the oversight body is the [https://www.cachwr.bc.ca/ BC Care Aide and Community Health Worker Registry].([[{{PAGENAME}}#References|5]]) In BC, HCAs must be registered to work in publicly funded facilities and services. To be registered, they are required to complete an approved BC training program or its equivalent and to submit a work history to the registry.

The registry has oversight only with respect to alleged cases of abuse or neglect of people receiving care. It does not address other competency issues––these are best addressed with the employer, or applicable licensing or registrar’s office. Employers must follow their own procedures for responding to allegations of patient or resident abuse by staff and may suspend the employee until an investigation of the allegation is completed.

Where an HCA has been suspended or terminated due to abuse or neglect, the employer must report it to the registry. While an employee is suspended from work pending investigation, the registry will also suspend the employee from the registry. Once the case has been reviewed or investigated and resolved, the registry may reinstate the employee or remove them permanently from the registry, depending on the investigation outcome.([[{{PAGENAME}}#References|6]])

The registry’s complaint records are not available to the public; they are restricted to employers who are also registered, as the data is used mainly for employment screening purposes.

For more information about the registry investigation process, see the [https://www.cachwr.bc.ca/About-the-Registry/Ensuring-Public-Safety.aspx registry’s website.]

HCAs working privately or for private care agencies are not legally required to register or to undergo a criminal record check.([[{{PAGENAME}}#References|7]]) If you have a complaint about an unregistered HCA working privately, there are few options other than to complain to the private agency that provided the service and discontinue the caregiver’s service. In this situation, it is important to begin searching for a new caregiver as soon as possible to ensure that a replacement is available when needed.

===Mental Health Review Board===

This section applies to any older adult who has been certified under the ''Mental Health Act'' as an involuntary psychiatric patient and is living on extended leave at home, in assisted living, or in long-term care.([[{{PAGENAME}}#References|8]])

Under the ''Mental Health Act,'' a person can be detained involuntarily if they have been certified by two physicians. Patients who are certified are generally detained in psychiatric units in hospitals but may also be detained on extended leave in other situations, such as assisted living or long-term care, if they abide by conditions set by a psychiatrist in consultation with the person’s health care team. These conditions often include continuing to take psychiatric medications and regularly attending appointments with a psychiatrist or mental health team. Other conditions may vary based on the person’s situation and could include not driving, or remaining in the province or country, for example.([[{{PAGENAME}}#References|9]])

If the individual on extended leave under the ''Mental Health Act'' does not abide by the conditions, they can be arrested and detained in a psychiatric hospital or unit.

For more information on criteria for certification and information about mental patient rights, see [https://www.bcmentalhealthrights.ca/wp-content/uploads/2018/05/MHARA-pamphlet-2018-interior.png. BC Mental Health Rights’ website.]

If you have questions about patient rights under the BC ''Mental Health Act'', contact [https://www.accessprobono.ca/our-programs/mental-health-program Access Pro Bono].

Seniors who are certified under the ''Mental Health Act'' and who wish to contest their detention can file an application for a hearing using a [https://www2.gov.bc.ca/assets/gov/health/forms/3507.pdf ''Form 7'']. The [https://www.bcmhrb.ca/ Mental Health Review Board] reviews the detention of people certified under the ''Mental Health Act''. Its role is to decide whether the person should continue to be held involuntarily. It does not deal with treatment issues or decide whether the initial certification was justified.

Once a hearing is scheduled, adults who cannot afford a lawyer can seek representation through the Mental Health Law Program run by [https://clasbc.net/get-legal-help/mental-health-law/ Community Legal Assistance Society] (CLAS) at 604-685-3425 in the Lower Mainland and 1-888-685-6222 elsewhere in BC.

==References==
# First Nations Health Authority, “Quality Care and Safety Office,” online: <http://www.fnha.ca/about/governance-and-accountability/quality-care-and-safety-office>.
# “Patient Care Quality Review Board Act,” SBC 2008, c 35, ss 1, 13, online: <http://canlii.ca/t/84pj>.
# “Assisted Living Regulation,” BC Reg 189/2019, Part 3, online: <http://canlii.ca/t/9lrn>; “Residential Care Regulation,” BC Reg 96/2009, Part 3 & 5, online: <http://canlii.ca/t/89ln>.
# “Hospital Act,” RSBC 1996, c 200, ss 6-8, 14, online: <http://canlii.ca/t/843c>.
# British Columbia, BC Care Aide & Community Health Worker Registry, “Home,” online: <http://cachwr.bc.ca>.
# Krista James & Sara Pon, “Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants, CCEL Study Paper 11” (October 2022: British Columbia Law Institute) at pg 124 to 130, online: “British Columbia Law Institute” <http://www.bcli.org/project/hca-oversight-in-bc/>.
# Krista James & Sara Pon, “Strengthening BC’s Health Care Backbone: Oversight of the Work of Health Care Assistants, CCEL Study Paper 11” (October 2022: British Columbia Law Institute), online: “British Columbia Law Institute” <http://www.bcli.org/project/hca-oversight-in-bc/>.
# “Mental Health Act,” RSBC 1996, c 288, s 22, online: <http://canlii.ca/t/846j>.
# “Mental Health Act,” RSBC 1996, c 288, s 22, online: <http://canlii.ca/t/846j>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Home Care and Senior Housing Whistleblower Protections

2024-03-21T00:39:08Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter6}}

==Whistleblower Protections==

Outlined below are channels for raising concerns and complaints related to home care, assisted living or long-term care. For more information about making a complaint, see the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/concerns-and-complaints province’s website].

It is against the law for care facilities and providers to retaliate in any way against a person who makes a complaint or raises concerns about the care someone is receiving. This is true whether the complaint comes from the older person receiving care, a staff person, family member, representative or guardian, or other concerned individual. The protection from retaliation extends to cover people in care who are not the ones making complaints, but about whom a complaint has been made. This means care facilities are not allowed to retaliate against a resident if they receive a complaint relating to that resident. For example, they cannot withhold or delay services to the resident, or threaten to evict or discharge the resident, or prevent a person who complained from visiting the resident.([[{{PAGENAME}}#References|1]])

==References==
# “Community Care and Assisted Living Act,” SBC 2002, c 75, s 22, 28.1, 28.2, online: <http://canlii.ca/t/84lk>; “Residential Care Regulation,” BC Reg 96/2009, s 60, online: <http://canlii.ca/t/89ln>; “Adult Guardianship Act,” RSBC 1996, c 6, s 46, online: <http://canlii.ca/t/84gj>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Medical Assistance in Dying in Home Care and Senior Housing

2024-03-21T00:38:27Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter5}}

==Medical Assistance in Dying (MAiD)==

To be eligible for MAiD, an adult must:

* a serious and incurable illness, disease, or disability;
* be experiencing an advanced state of decline that cannot be reversed;
* experience unbearable suffering that cannot be relieved in a way the adult feels is acceptable;
* be capable of making decisions about their health care at the time of application and assessment; and
* be able to clearly communicate their consent at the time of the procedure.

A person can request MAiD through their family physician or nurse practitioner, or by contacting the regional health authority’s [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] for guidance. The request must be submitted in writing on a specific form.

Before anyone can receive medical assistance in dying, they must be assessed by two independent doctors or nurse practitioners to determine whether they are eligible. A consultation with a third doctor or nurse practitioner who has expertise in the condition causing the person’s suffering may also be required. This process ensures that the individual is aware of all the care options available to them and has the information required to make an informed decision. A person who has been approved for MAiD may change their mind at any time.

An adult who has been approved for MAiD can have the procedure where they choose, including in a care facility. However, in BC care facilities run by faith-based organizations, and individual practitioners, can refuse to provide MAiD on-site for religious reasons. This is supported by an agreement between the provincial government and the Denominational Health Association. It means that residents of some faith-based facilities who want and qualify for MAiD must transfer to a facility that will provide the service.

==References==
# “Criminal Code,” RSC 1985, c C-46, s 241.1, online: <http://canlii.ca/t/7vf2>
# British Columbia, “Medical Assistance in Dying” (last visited 30 August 2023), online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/end-of-life-care/medical-assistance-in-dying>
# Canada, “Medical assistance in dying: Overview” (August 18, 2023), online: <http://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Home Care and Senior Housing Residents' Bill of Rights

2024-03-21T00:37:19Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter5}}

==Residents’ Bill of Rights ==

Facilities are very importantly the person’s home in which health care, assistance, and other support are provided on a regular, ongoing basis. They are where the resident lives and continues to have relationships with family and friends. It is important for residents to be able to enjoy everyday activities freely and with dignity.

However, while being the residents’ home, these facilities are also collective settings, and the exercise of an individual resident’s rights must be balanced against the health or safety of that resident and the rights of other residents and facility staff.

The ''Community Care and Assisted Living Act'' includes a ''Residents’ Bill of Rights'' for adults in care.([[{{PAGENAME}}#References|1]]) ''The Residents’ Bill of Rights'' applies to assisted living, long-term care, private hospitals and extended care facilities.([[{{PAGENAME}}#References|2]]) Although the Act does not generally apply to private hospitals and extended care facilities, the ''Resident’s Bill of Rights'' does. This is because it has been adopted under the ''Hospital Act'', which governs these types of facilities.

The ''Residents’ Bill of Rights'' aims to ensure that residents know their right to:

* receive individualized care based on their unique needs and preferences;
* live in an environment that supports their health, safety and dignity;
* participate in their own care planning and express concerns through accessible internal and external processes; and
* transparency and accountability from the operator – including access to information about the facility, full information about services and fees, refunds, and information about laws and policies affecting services.([[{{PAGENAME}}#References|3]])

The ''Residents’ Bill of Rights'' must be prominently posted in the facility in a form that is acceptable to the Minister of Health.([[{{PAGENAME}}#References|4]])

The ''Residents’ Bill of Rights'' is meant to address situations specific to assisted living, long-term care and extended care. It supplements the broader rights that are protected by the caselaw, human rights protections, and the ''Canadian Charter of Rights and Freedoms.''

This section will focus on key principles in the ''Residents’ Bill of Rights'':

===Commitment to Care (section 1)===

Adults in care have the right to a care plan that is developed specifically for them based on their unique abilities, needs, and cultural and spiritual preferences. It must be a personalized plan that recognizes the diversity of residents and their needs.

The law requires facilities to review care plans at least once a year, but this is a minimum standard. A care plan should be reviewed whenever there are significant changes in the resident’s circumstances, preferences, or health care needs.

If there is a concern that a resident’s care plan is not meeting their needs, the resident, their representative, or an advocate who has obtained their permission, can request and participate in a care conference to review the plan.([[{{PAGENAME}}#References|5]])

===Rights to Health, Safety, and Dignity (section 2)===

These broad rights cover many issues that arise in care facilities. These rights includes:

<blockquote>(a) to be treated in a manner, and to live in an environment, that promotes the person's health, safety and dignity;

(b) to be protected from abuse and neglect;

(c) to have the person's lifestyle and choices respected and supported, and to pursue social, cultural, religious, spiritual and other interests;

(d) to have the person's personal privacy respected, including in relation to the person's records, bedroom, belongings and storage spaces;

(e) to receive visitors and to communicate with visitors in private;

(f) to keep and display personal possessions, pictures and furnishings in the person's bedroom.([[{{PAGENAME}}#References|6]])
</blockquote>
''Access to an Interpreter (section 2a)''

People have a right to be treated in a way that promotes their health, safety, and dignity.([[{{PAGENAME}}#References|7]]) In the health care context, people have a right to be communicated with in a manner that fits their communication abilities.([[{{PAGENAME}}#References|8]]) If the resident’s first language is not English, it is important to provide an interpreter or a staff person who speaks the resident’s language, particularly in personal care situations where the resident may not understand what is happening and their dignity or safety may be compromised.

Interpretation services can be requested in advance through a provincial online booking system. However, this service may be difficult to access for daily living in care facilities as it is designed primarily for helping with scheduled appointments or meetings.

For more information see PHSA’s [http://www.phsa.ca/health-professionals/professional-resources/language-services/interpreting#Access--interpreters Provincial Language Service]. Interpretation service can be booked online or through the Provincial Health Service Authority phone line: 604-297-8400; toll-free: 1-877-BCTalks (228-2557).

In-person interpreters are not currently available for those outside the lower mainland health authorities (Fraser Health, Vancouver Coastal Health). Individuals outside the Lower Mainland will likely have to rely on virtual or telephone interpretation.

''Right to be protected from abuse and neglect (section 2b)''

Chapter seven addresses abuse and neglect and how to respond to it. See chapter seven for more details. The rest of this section provides an overview of substandard care.

Residents and their family members or representatives may have concerns about a variety of issues that fall within the scope of quality of care and ensuring the “health, safety and dignity” of residents. This may include substandard care such as poor housekeeping, delayed treatment, slow responses to call bells, lack of ambulatory care, lack of help with using the washroom, being forced to use incontinence products and being left for long periods without changing them, lack of attention to hygiene, infrequent baths, inadequate pain management, poor nutrition or rushed mealtimes. These are forms of neglect that adversely affect not only the health of the resident, but also their overall dignity and well-being.

Many of these issues are related to understaffing or inadequate staff training. Licensing and registration regulations([[{{PAGENAME}}#References|9]]) set out minimum requirements regarding “sufficient staffing” and staff skills and training, but do not specify staff to resident ratios or hours of individualized care.

When a facility fails to comply with these minimum requirements, a resident or representative can complain to the Home and Community Care Office, to Licensing, or to the Patient Care Quality Office. Where poor quality of care amounts to abuse or neglect, steps should be taken to intervene by reporting to a Designated Agency. However, it is usually faster and more effective to approach the facility operator or Director of Care to attempt to resolve quality of care issues internally.

''Lifestyle and social, cultural, religious/spiritual interests (section 2c)''

Care facility staff must respect and accommodate residents’ social identities and cultural, religious, and spiritual interests. This includes supporting an Indigenous resident’s wish to follow traditional practices or a non-binary or LGBTQIA+ resident’s free expression of their gender identity or sexual orientation.([[{{PAGENAME}}#References|10]])

''Privacy (section 2d)''

Residents have the right to personal privacy, including with respect to their medical records, personal possessions, and items stored at the facility. They have a right to privacy when receiving visitors, making phone calls. Facilities must provide a private phone and location for residents’ phone calls and a private area for visiting if the resident shares a room.([[{{PAGENAME}}#References|11]])

The use of video surveillance has become a privacy issue in care facilities over recent years. Whether initiated by the facility or by a resident’s family member or substitute decision-maker, the use of surveillance raises several ethical and legal concerns which continue to be debated. The ''Assisted Living Regulation'' now requires assisted living care homes to inform potential residents of any surveillance technology used on their site as a part of their residency agreement.([[{{PAGENAME}}#References|12]]) The ''Residential Care Regulation''([[{{PAGENAME}}#References|13]]) states that any long-term care facility that records images of residents or visitors must place a notice in a prominent place to notify people about the surveillance.

The use of “nanny cams” triggers privacy issues regarding the patient, staff, and visitors, and potentially lead to criminal charges. Relatives with concerns about the treatment of an older advice should consider less invasive measures, check the facilities’ policies and seek legal advice before using a videorecording device.

Some care facilities have developed policy on the use of surveillance cameras on their premises. These generally require consent by the resident, prior approval by the facility operator, and notices posted at entrances to inform those entering that surveillance cameras are in operation. The policies usually recommend trying all other options for resolving concerns before resorting to a method that involves such an intrusion on privacy.

''Visitor access (section 2e)''

The Bill of Rights gives residents have a right to have visitors and spend time with them in private.([[{{PAGENAME}}#References|14]]) This is confirmed in the ''Residential Care Regulations:''

<blockquote>(2)A licensee must, to the greatest extent possible while maintaining the health, safety and dignity of all persons in care, ensure that a person in care may

(a)receive visitors of the person in care's choice at any time, and

(b)communicate with visitors in private.([[{{PAGENAME}}#References|15]])
</blockquote>
Disagreements may arise over visitation rights. For example, a resident may disagree with their family member or representative about visitors, or care facility staff may restrict visiting times or bar specific people from visiting. The guiding principle is the resident’s wishes and their right to health, safety, and dignity.

The facility can restrict access to someone who they believe poses a risk to the safety or well-being of any resident or staff. This is an infringement of the resident’s right to have visitors, so this should not be done lightly. The facility is required to show that there is a reasonable basis for the belief that the visitor poses a risk, and the response must be proportionate to the actual risk present at that time.

If a family member or representative advises a facility to restrict a visitor’s access, it is important for the facility to determine whether the family member or representative has the authority to make such a decision for the resident. For example, someone with Power of Attorney to handle financial and legal matters does not have the authority to make personal decisions about visitors; nor does a temporary substitute decision-maker for health care decisions. A representative may have such authority if it is written in the Representation Agreement.

Anyone with the authority to make decisions about visitors on a resident’s behalf must exercise the authority according to the values, wishes, beliefs, and best interests of the resident. Remember that a substitute decision-maker only needs to step in when a resident does not have the capacity to make a specific decision for themselves. Most often residents do have the capacity to make a decision regarding visitation, and the best approach is for staff to ask the resident if they wish to see a particular visitor on a specific occasion.

If there is a court order barring a person from contacting the resident, the facility must comply with the court order and restrict that person’s access to the resident.

If the facility operator has a strong reason to believe that a visitor poses a risk to the health, safety, or dignity of the resident, the facility can apply for an interim court order to restrict the person’s visitation rights for up to 90 days under the ''Adult Guardianship Act''. Such an application must be based on a belief that the resident is being abused or neglected by the person. Chapter seven provides more details on responding to abuse and neglect.

''Right to keep possessions and furnishings (section 2f)''

Residents have a right to keep possessions and furniture in their room. Residents are allowed to decorate their room, including putting up personal photographs and art.([[{{PAGENAME}}#References|16]])

===Rights to Participation and Freedom of Expression (section 3)===

Residents have a right to participate in their care planning. Residents also have the right to express concerns and complaints. These rights can be exercised by the resident, their family, or their representative([[{{PAGENAME}}#References|17]])

''Care Planning''

The ''Bill of Rights'' specifies that adults in care have the right to participate in their own care planning including how the care is carried out. It is not enough for care providers to simply develop and communicate a care plan to the resident and their family member or representative. The resident and a family or representative must be given a meaningful opportunity to participate in developing the personalized care plan.([[{{PAGENAME}}#References|18]])

''Complaints ''

Residents have a right to express concerns or complaints, and care facilities must have a fair and effective process for resolving them. This resolution process must be communicated to residents and their families or representatives. Care facilities must also inform residents of how to make a complaint to an authority outside the facility if their concern is not resolved internally.([[{{PAGENAME}}#References|19]])

''Resident and Family Councils''

Residents of long-term care and their family members or representatives have the right to establish and participate in resident and family councils. The residents or family members must create these themselves.([[{{PAGENAME}}#References|20]])

Resident and family councils provide an opportunity for residents and their representatives to work together to improve the lives of residents, identify concerns, strategize solutions, and make recommendations to decision-makers. Residents may choose to have a separate residents’ council and family council, or to combine both functions together in a single council.

The ''Residential Care Regulation''([[{{PAGENAME}}#References|21]]) sets out additional requirements for long-term care operators. To support resident and family councils, long-term care operators are required to:

* provide meeting space for up to three hours for as many meetings as the council requests;
* provide administrative support to the counsel from an employee who is approved by the council;
* provide equipment for electronic participation, if requested;
* provide printed meeting minutes to residents and participants;
* provide information on policies and law as requested;
* meet with council members at least twice a year to address issues and recommendations; and
* receive, on behalf of the council, informational materials directed to the council from a health authority and forward the informational materials to council members in electronic or paper form, as requested by the council.([[{{PAGENAME}}#References|22]])

Operators and staff are not to attend meetings unless invited by the council members, and they cannot prevent a resident from attending a council meeting. Resident and family councils do not have decision-making authority, but facility operators are required to consider and make a written response to council recommendations in a timely manner.([[{{PAGENAME}}#References|23]])

Each health authority hosts a regional resident and family council network, and every resident and family council within the region is welcome to send a representative to participate in the regional council network. This gives participants the opportunity to communicate directly with local health authorities, to identify common concerns, and to develop broader, regional solutions. Regional councils in turn meet in a provincial group to discuss system-wide issues and propose systemic change to the Ministry of Health.([[{{PAGENAME}}#References|24]])

If there is no resident and family council at a particular facility, the facility staff should work with residents or family members and representatives to coordinate an initial meeting. The provincial government provides guidance on creating and maintaining a resident or family council in the [https://bccls-my.sharepoint.com/personal/nrussell_courthouselibrary_ca/Documents/Wikibooks/Senior%20Housing%202024/www2.gov.bc.ca/assets/gov/health/accessing-health-care/finding-assisted-living-residential-care-facilities/resident_and_family_councils_booklet.pdf Resident and Family Councils Booklet], available online.([[{{PAGENAME}}#References|25]])

Note that unlike long-term care facilities, assisted living facilities are not required to support resident and family councils.

===Transparency and Accountability (section 4)===

The ''Residents’ Bill of Rights'' requires facility operators to be transparent and accountable. Operators must provide access to copies of relevant laws, policies, and recent facility inspection reports. In addition, they must inform residents in advance of fee changes and must provide a written record of any prepayments and the terms for refunding such payments.([[{{PAGENAME}}#References|26]])

===Limits to Residents’ Rights (section 5)===

All rights set out in the ''Residents’ Bill of Rights'' may be limited by the need to protect a resident’s health and safety or those of other persons in care, and in consideration of what is reasonable and practical given the resident’s physical, mental, and emotional circumstances.([[{{PAGENAME}}#References|27]])

Many of the issues discussed above regarding health, safety and dignity are also addressed specifically in the ''Community Care and Assisted Living Act'', the ''Health Care (Consent) and Care Facility (Admissions) Act,''([[{{PAGENAME}}#References|28]]) or in health authority policies. The most common issues are medications, care planning, the use of restraints, access to palliative care and MAiD, and moving out of the care facility. Abuse and neglect are discussed in Chapter 7.

==References==
# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, online: <http://canlii.ca/t/84lk>

# “Hospital Act,” RSBC 1996, c 200, s 4, online: <http://canlii.ca/t/843c>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, s 57, online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(1), online: <http://canlii.ca/t/84lk>; “Residential Care Regulation,” BC Reg 96/2009, s 81, online: <http://canlii.ca/t/89ln>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(a), online: <http://canlii.ca/t/84lk>.

# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 8, online: <http://canlii.ca/t/842m>.

# “Residential Care Regulation,” BC Reg 96/2009, s 42, online: <http://canlii.ca/t/89ln>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(c), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(d), online: <http://canlii.ca/t/84lk>.

# “Assisted Living Regulation,” BC Reg 189/2019, s Sch C, s 3(e), online: <http://canlii.ca/t/9lrn>.

# “Residential Care Regulation,” BC Reg 96/2009, s 19(3), online: <http://canlii.ca/t/89ln>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(e), online: <http://canlii.ca/t/84lk>.

# “Residential Care Regulation,” BC Reg 96/2009, s 57(2), online: <http://canlii.ca/t/89ln>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(2)(f), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3)(a), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3)(d), (e), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(3)(b), (c), online: <http://canlii.ca/t/84lk>.

# “Residential Care Regulation,” BC Reg 96/2009, s 59.1, online: <http://canlii.ca/t/89ln>.

# “Residential Care Regulation,” BC Reg 96/2009, s 59.1, online: <http://canlii.ca/t/89ln>

# “Residential Care Regulation,” BC Reg 96/2009, s 59.1(3), online: <http://canlii.ca/t/89ln>.

# Vancouver Coastal Health, “Resident and Family Councils,” online: <http://www.vch.ca/en/service/resident-and-family-councils#short-description--15281>;

# British Columbia, Ministry of Health, “Developing, Supporting and Maintaining Resident Councils and Resident and Family Councils” (2022), online (pdf): <http://www2.gov.bc.ca/assets/gov/health/accessing-health-care/finding-assisted-living-residential-care-facilities/resident_and_family_councils_booklet.pdf>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(4), online: <http://canlii.ca/t/84lk>.

# “Community Care and Assisted Living Act,” SBC 2002, c 75, Schedule, s 1(5), online: <http://canlii.ca/t/84lk>.

# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, online: <http://canlii.ca/t/842m>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Temporary Leaves of Absences in Long-Term Care

2024-03-21T00:34:08Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter4}}

==Temporary Leaves of Absences==

===General Rule===

For reasons related to risk and safety, facility staff may try to restrict a resident’s right to leave the facility unaccompanied. However, if the resident has not been assessed as incapable, they are free to come and go as they please as they would be from any home. Preventing them from doing so is illegal.([[{{PAGENAME}}#References|1]])

The ''Residential Care Regulation''([[{{PAGENAME}}#References|2]]) requires ''long-term care facilities'' to ensure that any resident leaving the premises carries identification that includes their name, the care home they are living in, and emergency contact information.

If the resident has been assessed as incapable with respect to this kind of personal decision, then their care plan may specify conditions for leaving the facility, such as being accompanied by a family member, substitute decision-maker, or another person authorized by the representative. A resident who is capable may also have agreed in their care plan.([[{{PAGENAME}}#References|3]])

===Daily Outings===

A resident may leave a care facility as they wish unless they have been assessed as incapable.([[{{PAGENAME}}#References|4]]) However, The ''Residential Care Regulation'' requires that long-term care facilities ensure that when a resident leaves for a temporary purpose they have written documents with them indicating their name, the facility’s name, and emergency contact information. If the resident is at risk of leaving the facility without notifying staff, and may be unable to identify themselves, the facility must fit this person with a bracelet or other device that cannot be easily removed, which contains the identifying information. This requirement would typically be indicated in the resident’s care plan.([[{{PAGENAME}}#References|5]])

If a resident is planning to leave a care facility, even for a short period of time, it is best to give the facility advance notice so that staff can ensure the person is equipped with the necessary information and any medication or supplies they may need during their outing.

===Short Term Absences===

A resident may be absent from a long-term care facility for up to a total of 30 calendar days per year for personal reasons (for example, family visits), as long as they continue to pay their residential fees. The 30 days may be extended if the resident seeks health authority approval in advance. There is no limit on the amount of time a resident may be absent due to hospitalization.([[{{PAGENAME}}#References|6]])

However, temporary absences from long-term care are governed by policy only, not by law or regulation, and the policy does not go so far as to guarantee that the long-term care bed will remain available if the resident is absent for a significant amount of time, even for hospitalization. It is best to ask the facility directly about their policies for temporary absences. It is advisable for a resident who is absent to maintain regular contact with the facility to ensure their bed is held.([[{{PAGENAME}}#References|7]])

Private long-term care facilities may allow more lengthy temporary absences, but it is best to find out the facility’s policy and communicate regularly with them.

==References==
# “Health Care (Consent) and Care Facility (Admission) Act,“ RSBC 1996, c 181, s 25, online: <http://canlii.ca/t/842m>; British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D.2, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# “Residential Care Regulation,” BC Reg 96/2009, s 56(1), online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 25, online: <http://canlii.ca/t/89ln>; British Columbia, Ministry of Health, “ Home and Community Care Policy Manual,“ (6 February 2023) at ch 6.D.2, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 25, online: <http://canlii.ca/t/842m>.
# “Residential Care Regulation,” BC Reg 96/2009, s 56, online: <http://canlii.ca/t/89ln>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Use of Restraints in Long-Term Care

2024-03-21T00:32:51Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter4}}

==Use of Restraints==

''The Residential Care Regulation'' defines a restraint as any chemical, electronic, mechanical, physical or other means of controlling or restricting a care facility resident’s freedom of movement. This includes accommodating the person in a secure unit (for example, a locked wing of the facility).

The law does not specifically define chemical restraint, but other sources have described chemical restraint as the use of a medication to restrict a person’s movement, reduce a behaviour, or sedate a person beyond any therapeutic purpose. For more information about the use of chemical restraints, see the 2020 [https://www.bcli.org/consent-to-chemical-restraints-in-long-term-care/#:~:text=Consent%20to%20Restraints&text=Restraints%20can%20only%20be%20used,be%20used%20(s%2073) BC Law Institute blog] by Sara Pon.

The ''Residential Care Regulation'' sets out the general requirements for how and when restraints can be used in long-term care:

* Restraints can only be used if they are needed to protect the adult or others from imminent harm, and not for discipline or the convenience of staff.([[{{PAGENAME}}#References|1]])
* Restraints must be as minimal as possible.
* Other options must have been tried before restraints can be used.
* The adult being restrained must be monitored to protect their “safety and physical and emotional dignity”([[{{PAGENAME}}#References|2]])

These requirements must be met in every instance that restraints are used. In addition, the ''Residential Care Regulation'' sets out specific requirements for both emergency and non-emergency use of restraints.

If restraints are used in a non-emergency situation, the regulation requires prior consent from the resident or, if they are incapable of making decisions about restraint use, from their substitute decision-maker.([[{{PAGENAME}}#References|3]]) The resident’s physician or nurse practitioner must also agree. The resident or their substitute decision-maker and the health practitioner must both consent in writing. Note that the Public Guardian and Trustee cannot provide substitute consent for the use of restraints.([[{{PAGENAME}}#References|4]])

If restraints are used in an emergency, the regulation states:

* Prior agreement is not required if the adult or others are at imminent risk of harm.([[{{PAGENAME}}#References|5]])
* The use of restraints must be documented in the care plan; and
* After the restraint has been used, the facility must share information and advice regarding the restraint use, in a manner that fits the person’s skills and abilities, with:
** the resident,
** anyone who witnessed the restraint use, and
** any employees involved in the restraint use.([[{{PAGENAME}}#References|6]])

During restraint use, regular reassessments are required:

* The need for the restraint must be reassessed within the first 24 hours of using it.
* If the restraint is used in an emergency and continues for more than 24 hours, the adult or their substitute decision-maker and the adult’s doctor or nurse practitioner must agree to it.
* If the restraint is used with prior consent, reassessment must occur based on what is listed in the care plan or when the adult or substitute decision-maker has specified, whichever is earlier.([[{{PAGENAME}}#References|7]])

==References==
# “Residential Care Regulation,” BC Reg 96/2009, s 74, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 73, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 74, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, ss 74-75, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 74, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 73, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 75, online: <http://canlii.ca/t/89ln>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Overuse of Antipsychotic and Sedative Medications in Long-Term Care

2024-03-21T00:32:00Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter4}}
==Overuse of Antipsychotic and Sedative Medications==

Families and representatives often express concerns about medications that are prescribed to long-term care residents, particularly anti-psychotic drugs and sedatives. Their concerns are:
#whether the medication is being used to treat a condition or being used to subdue the resident;
#whether the benefits of the drug(s) outweigh the risks for the resident; and
#the lack of informed consent to the medication––usually meaning a lack of proper consultation with the resident or substitute decision-maker responsible for consenting to health care.

Overuse of anti-psychotic medications in seniors’ care is a long-standing problem. Such drugs are often prescribed to residents who may have dementia but no diagnosis of psychosis and may be prescribed without a full discussion of their risks and benefits with the resident or their substitute decision-maker. This violates the basic principle of informed consent to health care set out in the ''Health Care (Consent) and Care Facility (Admissions) Act.'' Risks of anti-psychotics and sedatives include increased confusion, falls, bedsores, blood clots, and potentially serious or fatal interactions with other drugs the adult may be taking. Medication is health care treatment, and residents or their decision-makers should be fully informed about the risks and benefits of any medications and maintain the right to refuse or consent to their use.([[{{PAGENAME}}#References|1]])

Family members may become aware of medications when they see a behavioural change in their resident family member. When raising questions with facility staff, they may be told that the medication is necessary to “manage” the resident, and if discontinued, it would lead to the patient’s deterioration. This also violates health care consent law and the rule against punishing people who make complaints.([[{{PAGENAME}}#References|2]]) The use of medication to control behaviour, rather than for therapeutic reasons, is a form of chemical restraint and is subject to regulations about restraint. The next section discuss restraints.

The Ministry of Health recognized the overuse of antipsychotic medications in care facilities and set guidelines to help service providers respond to behaviours with strategies to attempt before medication. These include thorough assessment of the resident, trying less risky interventions, and carefully weighing risks against benefits of various options.

Note that in some cases, antidepressants may be prescribed without a diagnosis of depression, as they are often effective for the management of chronic pain. This is not considered a chemical restraint unless it is used to control behaviour.

==References==
# Canadian Centre for Elder Law, “Conversations about Care: The Law and Practice of Health Care Consent for People Living with Dementia in British Columbia,” CCEL Report #10 (February 2019) at 115-139, online: <http://www.bcli.org/publication/conversations-about-care-the-law-and-practice-of-health-care-consent-for-people-living-with-dementia-in-british-columbia-full-report/>; Office of the Seniors Advocate of British Columbia, “Staying Apart to Stay Safe: The Impact of Visitor Restrictions on Long-Term Care and Assisted Living Survey” (November 2020) at pg 6, online: <http://www.seniorsadvocatebc.ca/osa-reports/staying-apart-to-stay-safe-survey/>.
# “Community Care and Assisted Living Act,” SBC 2002, c 75, Sch, online: <http://canlii.ca/t/84lk>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Care Plans in Long-Term Care

2024-03-21T00:31:12Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter4}}

This chapter discusses some common areas of concern while living in long-term care:

* care plans;
* use of antipsychotics or sedatives for behaviour management;
* use of restraints; and
* temporary absences from the residence.

==Care Plans in Long-Term Care==

A care plan is a document that records the care to be provided to an individual in a long-term care facility that considers the person’s unique abilities, physical, social and emotional needs, and cultural and spiritual preferences. Care plans provide guidance to caregivers so they can effectively care for and meet the unique needs of the person in care.([[{{PAGENAME}}#References|1]])

Facility operators are expected to conduct an initial assessment of the resident within 24 hours of admission. They must then develop a short-term care plan which identifies immediate care needs, risk factors, personal preferences, and a contact person.([[{{PAGENAME}}#References|2]])

Operators are also required to develop a comprehensive care plan within 30 days of the adult’s admission. This is created with the adult, their supporters, and the care team in a care conference. The older adult has a right to take part in developing the care plan. The facility is required to monitor the resident’s needs regularly and to review and adjust care plans at least annually and whenever there is a substantial change in health or circumstances. The facility must make reasonable efforts to involve the resident and their family member or representative in care planning and in any changes to a care plan. The planning team will gather information about the individual’s abilities and needs and determine how best to provide care.([[{{PAGENAME}}#References|3]])

Care plans vary because they are tailored to the individual. Elements of a care plan may address:

* medication;
* oral health;
* nutrition;
* recreation and leisure;
* fall prevention;
* considerations about wandering and behavioural interventions;
* emotional and social needs;
* cultural and spiritual preferences; and
* other factors involved in ensuring the health, safety, and dignity of the resident.([[{{PAGENAME}}#References|4]])

The care plan will be shared with the individual’s health care team to ensure consistency in care.

A care plan may identify circumstances in which restraints may be used. In order for restraints to be used, the resident or their substitute decision-maker must provide prior written consent to the use of restraints. There is an exception when it is an emergency and necessary to protect a person from harm.([[{{PAGENAME}}#References|5]])

Ongoing care planning and the involvement and consent of the resident or their substitute decision-maker is a general issue that arises in care facilities, not just with respect to medications.

If there is an issue regarding the resident’s type or quality of care, or if a family member or representative notices a significant change in the resident, they can request a care planning conference. Facility operators are required to hold care conferences at least annually, but also whenever there is a significant change in the resident’s condition or circumstances. Operators must make every effort possible to include the residents, their family members, or their substitute decision-maker in care planning.([[{{PAGENAME}}#References|6]])

For more information about care plans, see [https://www2.gov.bc.ca/assets/gov/health/accessing-health-care/finding-assisted-living-residential-care-facilities/residential-care-facilities/fact_sheet_careplan_residential.pdf regional health authority websites.]

If language is a barrier, an interpreter should be present at the assessment and care conference. An interpreter can be requested in advance through a provincial online booking system. For more information see the [http://www.phsa.ca/health-professionals/professional-resources/language-services/interpreting#Access--interpreters Provincial Health Services Authority’s website]. If someone is unable to book online, interpretation service can also be booked through the Provincial Health Service Authority phone line: 604-297-8400; Toll-free: 1-877-BCTalks (228-2557). Unfortunately, onsite interpreters are currently only available for Lower Mainland health authorities (Fraser Health, Vancouver Coastal Health). Individuals outside the Lower Mainland will have to rely on virtual or telephone interpretation.

===MOST Forms and Advance Directives ===

The care plan may also include advance directives and end of life planning if these have been discussed with the resident and their family or authorized representative.

Care facility operators may suggest or cite a MOST document as a care planning tool. This refers to a “Medical Order for Scope of Treatment” which is normally completed by a doctor in consultation with a patient and kept with the patient’s medical information. It outlines the level of care that a person would like if they were unable to speak for themselves in a medical emergency. It is essentially a form of advance care directive. Some facilities may insist on such a document at admission, but this is not a legally required condition for admission.([[{{PAGENAME}}#References|7]])

A MOST document can be a useful tool for patients to communicate their wishes to health care workers providing emergency care. However, there are other forms of advance care planning that individuals may want to consider, including making a representation agreement. For more information about advance directives and representation agreements, see [https://www.nidus.ca/PDFs/Nidus_AdvanceDirective-BC.pdf Nidus’ website] and [https://www.peopleslawschool.ca/understand-most-forms/ People’s Law School website.]

==References==
# “Residential Care Regulation,” BC Reg 96/2009, s 81, online: <http://canlii.ca/t/89ln>; British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 2.A, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# “Residential Care Regulation,” BC Reg 96/2009, s 80, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 81, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 81, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 84, online: <http://canlii.ca/t/89ln>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 2.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# People’s Law School, “MOST (medical orders for scope of treatment) forms” (June 2019), online: <http://www.peopleslawschool.ca/understand-most-forms/>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Ending Long-Term Care Residency

2024-03-21T00:29:24Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter3}}

==Ending Residency==

===General Rule===

A resident may choose to end their residency for a variety of reasons. The right to terminate residential care is set out in the legislation. It states that a care facility cannot prevent a resident from leaving the facility if the resident is capable of making the decision about ending their residency. If the resident has been assessed as incapable of such a decision, then the person authorized to act as their substitute decision-maker may remove them from the care facility. A facility must ensure that a resident is not released or removed from the facility by anyone except the person’s representative, substitute decision-maker, or someone authorized in writing by the resident. ([[{{PAGENAME}}#References|1]])

===Voluntarily Leaving Long-term Care===

There are two circumstances where a care facility must initiate an assessment of capability of a resident who has expressed a desire to leave a long-term or extended care facility:

* When a facility operator doubts a resident’s capacity to make a decision about continuing or ending their residency they must, within a reasonable amount of time, have the resident assessed for incapacity. ([[{{PAGENAME}}#References|2]])
* When a resident has previously been assessed as incapable and does not have a substitute decision-maker, but the facility operator believes the resident may be capable of making a decision about continuing or ending their residency, then the facility must have the resident reassessed in a reasonable time. ([[{{PAGENAME}}#References|3]])

Determinations of incapability must be made by a medical practitioner or a prescribed health care provider. ([[{{PAGENAME}}#References|4]]) The ''Residential Care Regulation'' sets out how assessments must be done.

There are exceptions to the two circumstances outlined above. A resident must remain at the facility if:

* a resident assessed as incapable expresses the desire to leave the facility within 30 days of being admitted; or
* if consent to the continued accommodation of the resident was given by the substitute decision-maker within the last 90 days. ([[{{PAGENAME}}#References|5]])

When an adult leaves a residential care facility, operators are required to ensure the resident’s needs will be met in their chosen accommodation. The resident or their substitute decision-maker should give the facility advance notice of the decision to leave. This will ensure that the facility can follow discharge procedures and organize a care plan meeting where care staff can inform the resident and/or family or substitute decision-maker about what ongoing care will be needed. If the adult’s needs are not met, this may lead to a situation of abuse or neglect, for which caregivers are responsible under the ''Adult Guardianship Act (''see Chapter 7, Abuse and Neglect).

===Eviction ===

There may be circumstances in which a long-term care facility evicts a resident. The law is silent regarding evictions from long-term care, other than the rule against evictions or discharge as retaliation for complaints. The ''Residential Tenancy Act'' does not apply to care facilities. However, long-term care facilities may have policies regarding eviction, and if so, these should be explained to the resident upon admission. In addition, the ''Home and Community Care Policy Manual'' specifies some reasons for no longer qualifying for a care facility. ([[{{PAGENAME}}#References|6]])

The most common reason for eviction is the failure to pay fees. Ideally this should not occur for those receiving subsidized care as their fees are based on income, but it may occur due to the resident being incapable of issuing payments or where another person managing their finances has failed to make payments. This issue may arise, for example, when a resident and their substitute decision-maker share a joint account and the substitute decision-maker uses the funds for something else. In these circumstances the facility or a concerned person should find out whether the resident has appointed someone to manage their finances. If no such person is identified, or if the appointed person is mismanaging finances, then the Public Guardian and Trustee should be notified that the resident is having difficulties handling their financial affairs. For more information on how to contact the PGT and what they will do, see the section on [[Public Guardian and Trustee Intervention in Home Care and Senior Housing|Public Guardian and Trustee Intervention]] in Chapter 7 of this guide, and the [https://www.trustee.bc.ca/services/services-to-adults/Pages/assessment-and-investigation-services.aspx PGT’s website.]

If the Public Guardian and Trustee becomes involved, they may appoint someone to manage the person’s finances. Note: In BC there is a non-profit organization called the Bloom Group which will manage the finances of low-income individuals for a nominal fee.

Another reason for eviction is when a care facility ends their agreement with the regional health authority to provide subsidized beds, and residents in those subsidized beds are forced to move out. In this case, the resident or concerned person should contact the health authority, as they will likely take on the responsibility of finding an alternate care facility.

While it is uncommon, it is possible for an individual to be discharged from long-term care if they no longer require the level of support provided by the facility. This is most common with short-term stays where the person has been receiving care to recover from an injury or illness until they can live more independently. When this occurs, the resident or family caregivers should communicate with the health care team for instructions regarding follow-up care. They may also wish to contact the local [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] to arrange an assessment for home care if the adult will require help while continuing to recover at home.

===Palliative Care ===

An older adult may receive palliative care if they are diagnosed with a life-limiting illness or condition. They can receive palliative care in long-term care if they wis, in a hospital, or in hospice. A diagnosis is usually determined by the adult’s family physician, and palliative services are coordinated by the [https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/how-to-arrange-for-care Home and Community Care Office] of the regional health authority. Palliative care can be provided alongside therapeutic treatment and has been shown to improve quality of life when started early after a diagnosis.

A palliative designation means that the Medical Services Plan will cover costs for certain palliative medications, supplies and services, which can be provided at home, in a care facility, or in a hospice. Palliative care also includes support to family members and addresses the social, emotional, and spiritual needs of the patient.

==References==
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 25, online: <http://canlii.ca/t/842m>; “Residential Care Regulation,” BC Reg 96/2009, s 58, online: <http://canlii.ca/t/89ln>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 25, online: <http://canlii.ca/t/842m>.
# “Residential Care Regulation,” BC Reg 96/2009, s 50.1, online: <http://canlii.ca/t/89ln>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 26, online: <http://canlii.ca/t/842m>.
# “Residential Care Regulations,” BC Reg 96/2009, s 50.1, online: <http://canlii.ca/t/89ln>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at chs 5-6, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Consent to Admission in Long-Term Care

2024-03-21T00:28:19Z

Justin Lee: /* References */

{{Navigating Home Care and Senior Housing: An Advocacy Guide TOC|expanded = chapter3}}

==Consent to Admission==

Once a person agrees to enter a particular care facility, they or their substitute decision-maker will be asked to confirm their consent to admission based on the information provided.([[{{PAGENAME}}#References|1]])

The law is silent on the question of written residency agreements for long-term care. However, to ensure prospective residents are given the opportunity to make an informed decision about admission, facilities are required provide the following information:

* what care will be provided;
* what services are available to the resident; and
* when the resident can leave the facility.([[{{PAGENAME}}#References|2]])

The ''Residential Care Regulation'' details what information long-term facilities must provide to ensure the resident or their substitute decision-maker makes an informed decision:

* all charges, fees, or other payments that the person in care may have to pay in return for accommodation and services provided by the care facility;
* the policies of the care facility regarding expressing concerns, making complaints, and resolving disputes;([[{{PAGENAME}}#References|3]]) and
* how the person, or the person's representative, may express concerns or make complaints to the medical health officer, or if applicable, to the Patient Care Quality Office and PCQ Review Board([[{{PAGENAME}}#References|4]]) (under the ''Patient Care Quality Review Board Act''([[{{PAGENAME}}#References|5]])).

The care facility operator must ensure that they communicate in a way that fits the skills and abilities of the person or the person's representative. However, this does not necessarily mean providing a written version of the above information.([[{{PAGENAME}}#References|6]])

Long-term care facilities must document the resident’s consent to admission in writing. This may be done on a standard [https://www2.gov.bc.ca/assets/gov/health/forms/3909fil.pdf Care Facility Admission Consent form] (HLTH 3909) or an adapted form that includes the following:

* the name of the adult being admitted;
* the name of the specific care facility for which consent to admission has been given;
* the form of consent given – i.e. oral, written, or inferred from conduct;
* signature of the resident to indicate consent, or of their substitute to indicate consent; and
* signature of care facility operator or manager if consent has been given by the resident orally or by inferred conduct or given by a substitute decision-maker.([[{{PAGENAME}}#References|7]])

The completed consent form must be provided to the facility prior to admission.

An older adult is not required by law to provide any of the following to be admitted to long-term care:

* A designated substitute decision-maker in case the resident is assessed in the future as incapable of making health care or personal care decisions. In some cases, individuals have been asked to “nominate” someone on admission. This nomination process does not meet the legal requirements of appointing a representative or an attorney under a POA. If the resident has no legally appointed substitute decision-maker, the legislation specifies how the care facility is to identify an appropriate substitute decision-maker and what that person’s responsibilities are.([[{{PAGENAME}}#References|8]])
* A guarantor to pay the resident’s fees if they default on payments. If a substitute decision-maker is managing the resident’s finances and is paying the fees from the resident’s funds, they are not personally liable for any fees the resident cannot pay. A resident who is unable to pay their monthly fee can apply to the health authority for a temporary fee waiver.([[{{PAGENAME}}#References|9]])
* Advance planning documents, such as an advance directive, representation agreement, power of attorney document, or committee appointment. While such information can be helpful for a care facility, it is not a requirement for admission. Residents are not required to sign an advance directive as a condition of receiving services.([[{{PAGENAME}}#References|10]])

Operators may request some of the above information when an adult is being admitted to long-term care. The adult is not required to provide this information. This is an area where an advocate can ensure that admission requirements are met by the facility but do not include (or pressure the adult to include) conditions that are not legally required.

==References==
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 20-22, online: <http://canlii.ca/t/842m>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 21(1)(d), online: <http://canlii.ca/t/842m>.
# “Residential Care Regulation,” BC Reg 96/2009, s 60, online: <http://canlii.ca/t/89ln>.
# “Residential Care Regulation,” BC Reg 96/2009, s 48, online: <http://canlii.ca/t/89ln>.
# “Patient Care Quality Review Board Act,” SBC 2008, c 35, online: <http://canlii.ca/t/84pj>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 21, online: <http://canlii.ca/t/842m>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D.2, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 16, online: <http://canlii.ca/t/842m>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 7.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# “Health Care (Consent) and Care Facility (Admission) Act,” RSBC 1996, c 181, s 19.91, online: <http://canlii.ca/t/842m>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Long-Term Care Placements

2024-03-21T00:26:29Z

Justin Lee: /* References */

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==Placements==

===Placement Decisions===

Placements are managed by a case manager from the Home and Community Care office, not by the facility operators. Placements are filled according to specific criteria:

* the level of need and level risk to the adult where they are currently living;
* the person’s preferred facilities; and
* whether the preferred facility can meet their care needs.

Typically, people with the highest risk level are given priority.([[{{PAGENAME}}#References|1]]) Veterans Affairs Canada also designate priority access beds([[{{PAGENAME}}#References|2]]).

Facility operators will provide the case manager with an opinion on whether their facility can meet the needs of the prospective resident.

Waiting periods may vary based on the personal criteria above, as well as overall availability of spaces. Some health authorities provide information about approximate wait times online.

When an adult has been approved for subsidized placement in a care facility, health authorities have obligations to support the adult while they are in community waiting to enter the facility. Health authorities must ensure that adults in this situation are supported with:

* a care plan that meets their needs while waiting for access; and
* an increase in availability and flexibility of community health services, where required.([[{{PAGENAME}}#References|3]])

===Placement Offers===

When an appropriate facility becomes available, the case manager will contact the adult or their representative to offer a placement. There is only a very short time to accept or decline the offer and move in –– 48 hours if it is a space in one of the person’s preferred facilities, and 72 hours if it is in a temporary interim facility. This means that the decision is often made quickly.([[{{PAGENAME}}#References|4]])

Therefore, it is important to be well informed and prepared in advance for this decision. This includes planning for the move during the waiting period, which may involve downsizing significantly, arranging ongoing medical care, organizing finances, and learning about the potential consequences of accepting or declining the placement offered.

===Interim Placement Offers===

Your waitlist date will be the date you choose your preferred care home. You will maintain your position on the waitlist regardless of where you are waiting. An adult may accept an interim placement without impacting their waitlist date.([[{{PAGENAME}}#References|5]])

The Ministry of Health’s Home and Community Care Policy Manual requires health authorities to:

* allow the client or substitute to change their choices of preferred care homes up until they are offered care and accommodation in one of their preferred care homes with no impact to their original waitlist date;
* decline an interim placement with no penalty;
* ensure a client maintains their place on the waitlist for their preferred care homes while waiting for admission, even if they move into an interim care home; and
* manage a client’s requested transfer to a preferred care home fairly when the client has accepted temporary placement in an interim facility.([[{{PAGENAME}}#References|6]])

If a person is in hospital and declines an offer of interim or preferred long-term care placement they will be charged a daily rate for hospital acute care while they remain in hospital.([[{{PAGENAME}}#References|7]])

If a person declines placement in an interim or a preferred facility, they will be advised of other care options, including subsidized care, private care, and family caregivers. If they are declining because they want to change their preferred facility, their waitlist date will be changed to the date of the change.([[{{PAGENAME}}#References|8]])

If a person living in an interim long-term care facility decides they wish to remain at this interim facility, they can decide to do so and be removed from the waitlist for their previous preferred facilities.([[{{PAGENAME}}#References|9]])

==References==
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.C, 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Canada, “Long-term Care” (last modified February 8, 2019), online: <http://www.veterans.gc.ca/eng/housing-and-home-life/long-term-care>; British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia, “Long-Term Care Services,” online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/long-term-care-services>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Choosing a Long-Term Care Facility

2024-03-21T00:24:49Z

Justin Lee: /* References */

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==Choosing a Long-Term Care Facility==

Once a person has been assessed by Home and Community Care Services and accepted as eligible for subsidized assisted living or long-term care, they will be asked if they have a preferred facility. The adult can name up to three preferred facilities and will be waitlisted for those. An adult is free to change their choice of preferred facility up until the time they are offered a placement. The adult may be asked if they would consider another temporary option if it becomes available sooner––called an interim facility. Applicants are not required to consider interim facilities, but this option can be helpful if the adult needs immediate care and cannot get into the facility of their choice soon enough.([[{{PAGENAME}}#References|1]])

It is important for prospective residents or trusted family members to research available facilities to find out which are suitable. To find facilities in a particular community, look on the local regional health authority website, where there will be links to assisted living and long-term care facilities by location. Many care homes will have their own website with photos and further information about their philosophy of care. Individuals can contact facilities they are interested in and arrange a visit.

Suitability for the resident may be based on a variety of factors such as closeness to friends and family who would visit, policies about alcohol, smoking or visiting, availability of staff who speak the person’s language, cultural, or religious preferences, the facility’s philosophy of care, their use of restraints, and inspection reports. VCH provides a useful list of questions to ask to determine suitability in their [http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf ''Introduction to Long-Term Care Handbook.''([[{{PAGENAME}}#References|2]]).

==References==
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 6.D, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# Vancouver Coastal Health, “Introduction to Long-Term Care Handbook Helping you make the best choice for your care” (2019), online (pdf): <http://www.vch.ca/sites/default/files/import/documents/Introduction-to-Long-Term-Care-Handbook.pdf>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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Cost of Publicly Funded Long-Term Care

2024-03-21T00:23:58Z

Justin Lee: /* References */

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==Cost of Publicly Funded Long-Term Care ==

Fees for publicly funded long-term care are set by the Ministry of Health under the ''Continuing Care Act''([[{{PAGENAME}}#References|1]]) and the ''Continuing Care Fees Regulation''.([[{{PAGENAME}}#References|2]]) The Ministry of Health sets the formula for calculating subsidized fees and may adjust it periodically. Individual fees are assessed annually, based on the resident’s current income tax assessment. This is not decided by individual facilities.

The fee is based on the resident’s after-tax income as assessed by the Canada Revenue Agency (CRA) and reviewed and adjusted annually. Residents who want to qualify for a subsidized rate must formally consent to share their income information with the health authority. The health authority may not share income information with facility operators, only the assessed fee.

Financially eligible residents pay a monthly fee. There is a minimum and maximum client fee per month. For residents who fall between the minimum and maximum client, fee, they pay a rate of 80% of their after-tax income. For those residents who have an after-tax income under $1625, they pay a rate of their after-tax income minus $325.([[{{PAGENAME}}#References|3]])

There are fixed fees for residents of long-term care who are receiving support or shelter allowance under the ''Employment and Assistance Act''([[{{PAGENAME}}#References|4]]) or the ''Employment and Assistance for Persons with Disabilities Act.'''([[{{PAGENAME}}#References|5]])

If payment of the assessed monthly rate would cause serious financial hardship to a resident or their family, they may apply to the health authority for a [https://www2.gov.bc.ca/assets/gov/health-safety/home-community-care/who-pays-for-care/who-pays-for-care/supporting_documentation_checklist_for_trr_applications_final.pdf temporary rate reduction] for up to 1 year. If this hardship persist beyond the original rate reduction period, the resident or their family may re-apply.([[{{PAGENAME}}#References|6]])

The ''Residential Tenancy Act''([[{{PAGENAME}}#References|7]]) does not apply to care facilities. However, operators of subsidized care facilities cannot change rates unless authorized by the regional health authority. The fees in private hospitals are not regulated.

==References==
# “Continuing Care Act,” RSBC 1996, c 70, online: <http://canlii.ca/t/84gx>.
# “Continuing Care Fees Regulation,” BC Reg 330/97, online: <http://canlii.ca/t/85gj>.
# British Columbia, Ministry of Health,” Home and Community Care Policy Manual,” (6 February 2023) at ch 7.B, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>; “Continuing Care Fees Regulation,” BC Reg 330/97, online: <http://canlii.ca/t/85gj>.
# “Employment and Assistance Act,” SBC 2002, c 40, online: <http://canlii.ca/t/84l7>.
# “Employment and Assistance for Persons with Disabilities Act,” SBC 2002, c 41, online: <http://canlii.ca/t/84l8a>.
# British Columbia, Ministry of Health, “Home and Community Care Policy Manual,” (6 February 2023) at ch 7.B, online: <http://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards/home-and-community-care-policy-manual>.
# “Residential Tenancy Act,” SBC 2002, c 78, online: <http://canlii.ca/t/84lm>.

{{REVIEWED | reviewer = Seniors First BC, February 2024}}
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